Why is medical staff credentialing done? And what is it?

medical staff credentialing

Why is medical staff credentialing done? And what is it?

Nurses, physicians, and patients comprise the family within the healthcare sector. These three are necessary for the medical field to consist solely of a map of abandoned structures called hospitals. Any hospital's doctors, nurses, and patients who come in for care for various health conditions make up its core. Every hospital or clinic that tries to give its patients high-quality medical care is true to this statement. After all, without patients and doctors, there would be no way to address medical conditions. Therefore, hospitals hire physicians and nurses only after checking their credentials and reviewing their professional histories. Medical credentialing occurs here.

What exactly does medical staff credentialing entail?

As the name implies, medical staff credentialing is the process of confirming the validity and worth of the hospital personnel's medical credentials. This approach is essential for hiring highly competent physicians to foster excellence in medical care. Building a hospital's reputation as a top medical care facility and employee credentialing are equally vital. However, employing unqualified physicians could further hurt a hospital's reputation, impacting its revenue flow. As a result, hospitals prefer using reputable medical billing companies to handle the credentialing of their medical staff. To help hospitals with the administrative credentialing process, the medical billing companies designate a medical staff credentialing specialist. The credentialing specialist is in charge of approving the applications of the most appropriate people.

Why are credentials for medical staff needed?

Verifying a doctor's credentials, including their medical degree, diploma, internship, residency, and fellowship certifications, healthcare license, and National Provider Identifier number, is the primary goal of medical staff credentialing. In addition, a physician's professional background is looked at, along with any malpractice claims and disciplinary actions.

Additionally, medical staff credentialing is carried out by ethical principles. This is one of the best methods to build trust and close relationships between the hospital and its patients. A hospital that employs the best skilled medical professionals is implicitly committed to providing its patients with the highest care and attention. An unseen link prevents patients from going to another hospital since they are confident they receive the best care possible.

What do individuals in the medical staff credentialing field perform?

A Medical Staff Credentialing Professional has several vital duties, regardless of the sort of organization they work for. Processing applications and checking credentials is their main area of attention. Regarding credentialing and privileging, they are in charge of checking all original and reappointment applications for completeness in compliance with regulatory and accreditation criteria and all supporting papers. Each practitioner must be informed of the status of their application, as well as any necessary deadline extensions for submitting any relevant extra information. They must identify, look into, and evaluate discrepancies and unfavorable information gleaned from the application, the initial source verifications, or other sources regarding primary source verification. This is done to make sure the review and approval bodies have the knowledge they need to decide on membership or privileges credentialing in an educated manner.

To validate the accuracy of applications for one or more decision-making bodies, medical staff credentialing professionals must gather and assess data from primary sources to verify compliance with regulatory and accreditation criteria. To assure compliance with regulatory standards, they must further verify and document expirable using appropriate validation sources.The department chair or medical director analyzes and recommends the application after it is finished. Hospital employees frequently use an evaluation by a credentials committee. The application, any accompanying materials, and the chairperson's/medical director's proposal are all reviewed by this committee, which then uses this data to formulate its recommendation to the medical executive committee (MEC).The application is frequently offered to the MEC directly in smaller healthcare settings or non-departmentalized facilities. The board then hears the MEC's final recommendation, and the board renders the final judgment. It's crucial to remember that while MCOs do not give privileges, they do verify an applicant's eligibility for membership or participation and handle privilege requests to make sure they comply with legal requirements.


Medical Staff Credentialing Professionals sometimes must devote much effort and time to their jobs. When a task necessitates such careful planning, it is advantageous to have resources available to help one stay organized and on track. Medical Staff Credentialing Professionals at Intellimedx manage initial and re-credentialing, enrollment, onboarding, expirable management, privileging, evaluation, network administration, and much more with the assistance of Intellimedx and our staff of credentialing specialists.