Why Credentialing Matters

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We live in a time where buzz words like “patient safety” and “value-based health care” are hot trending topics. But how do we know people responsible for patient care and safety have what it takes? How do we distinguish professionals—with years of medical training and experience—from amateurs?


The simple answer to both questions is credentialing. Credentialing is the process of verifying the qualifications of licensed health care professionals. It is an essential component of health care.

Patient Care and Accountability

Credentialing helps protect patients and health care organizations by lowering the risk of possible medical errors caused by unqualified providers. It enhances the reputation and credibility of health care providers, payers and the wider health care network. And it protects the public by assuring patients that health care providers meet standards of practice.

Health care organizations must ensure providers are credentialed in an efficient and accurate way. Many hire others—certified credentialing entities–to perform the checks.

Quality Indicator

Credentialing is an indicator of quality. As you know, NCQA holds health care organizations accountable on all things quality related. Credential review is no different.

We offer Credentialing/ Recredentialing (CR) Certification and Credentials Verification Organization (CVO) Certification programs to health care organizations and individuals. Both programs help organizations demonstrate that they have the processes in place to perform thorough, timely and accurate credential verification. The programs provide a framework that identifies opportunities to align organizational processes with NCQA requirements. Organizations that earn certification are listed on NCQA’s Web site, distinguishing their capabilities to prospective clients and patients.

You can also learn more about the process of earning NCQA credentialing certification by visiting the NCQA Web site here.

Shireesha Jevaji
Shireesha Jevaji is the Senior Public Policy and Communications Specialist at NCQA and has been with the organization since 2012. She supports NCQA’s external communications for the consumer audience and public and private stakeholders. She also conducts data analysis for infographic and publication production and measures outreach impact. Shireesha is currently working towards her MPH in Public Health Communication and Marketing at the George Washington University.

2 thoughts on “Why Credentialing Matters

  1. Credentialing is an extremely important process in supporting healthcare quality, compliance, and risk management. The problem is many payers have credentialing processes which take too long. These time consuming processes negatively impact revenue cycle and organizations abilities to onboard providers in a timely manner. Help is needed to improve credentialing practices at the State and Federal levels.

  2. One managed care organization (MCO) in whose provider network we participate insists the NCQA does not require credentialing of anesthesiologists, pathologists, radiologists, and other hospital-based physicians. Is this true?

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