December 4, 2018

From Bedside Nurse ➡️ NP Student: Credentialing Process

I got a job, oh my god! Someone believed in me and is willing to train me, AND it's a well-renowned hospital in Tampa, Florida.

My new job is an ARNP of Cardiovascular Surgery at a Cardiothoracic ICU!

I am beyond excited to start. I wanted to explain the credentialing process because I was unaware of what was involved and I grossly underestimated the time frame needed to verify my information. Now, each state is different, but all government agencies require this type of professional verification. The credentialing process involves the confirmation of an applicant's education, eligibility, licensure, certifications, risk potential, and professional references. Credentialing is the practice hospitals use to evaluate and verify the qualifications of their healthcare providers to ensure that each individual practitioner possesses the necessary qualifications to provide medical services to their respective patients. Once a practitioner is credentialed, the hospital will take further steps to assess the practitioner’s competence in a specific area of patient care, through a process known as privileging.

The time frame of credentialing can range from 30 - 200 days, depending on the institutional processes and how prompt you are at providing the required documentation. It's a long process and will involve you speaking to multiple people and being on top of things. I recommend anyone who is starting this process to check your inbox often and check with your medical office contact frequently to make sure you are on your way to heading to orientation in a reasonable timeframe. Because often, hospital committees meet only certain times per month. So if your paperwork isn't completed and in before the meeting documentation deadline, you will have to wait until the next meeting for consideration and approval.

Oh, and oftentimes you have to come out of pocket money-wise for the verification process, but you will be reimbursed after you're approved. Weird, I know. But do you expect a company to do all this legwork, pay multiple companies to verify your information, to then find out you're under house arrest after investing $250 in getting you credentialed? I know, it's annoying but make sure you ask this upfront. Some places cover this upfront cost for you, but just make sure you ask.

Your employer's medical office will usually manage all the verifications and document processing for you. Don't do any of this on your own. I broke down my verification process for information purposes only. Your employer will have procedures for obtaining this information. The only thing you have to independently obtain is your NPI Number. The rest will be done for you, usually.

What did my credentialing process include?

1. Copy of Master's of Science degree in Nursing (MSN)

2. Copy of college transcript for Master's of Science degree in Nursing (MSN)

3. Apply (it's free) and obtain CMS National Provider Identification (NPI) Number

  • The NPI is a Health Insurance Portability & Accountability Act (HIPAA) standard. It is a 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services
  • https://npiregistry.cms.hhs.gov

4. Verification: National Practitioner Data Bank (NPDB) Screening

  • Information on medical malpractice payments and certain adverse actions related to health care practitioners and providers
  • https://www.npdb.hrsa.gov

5. Verification: Office of the Inspector General (OIG) Background Check

  • Individuals on the List of Excluded Individuals and Entities are barred from participating in federal health care plans. Hiring these individuals may result in civil monetary penalties as well as loss of reimbursement
  • https://exclusions.oig.hhs.gov

6. Verification: System for Award Management (SAM) Screening

  • Screening against SAM Exclusions is essential for companies that hold Federal contracts and need to screen subcontractors that will work on the federal contract, as well as any company associated with federal assistance
  • https://dev.sam.gov/index.html

7. Verification & Audit: Malpractice Insurance Records

  • During your nurse practitioner program (college insurance coverage information - for all years of attendance) 

8. Verification: ARNP Certification  - AANP / ANCC

9. Verification: Other Certifications - CCRN / CMC / CVRN / FCCS

10. Verification: Course Provider Cards - BLS / ACLS / PALS / NRP

11. Professional References - ARNPs / MDs /DOs only (at least three, active in roles)

12. Verification: Department of Health - State Nursing Licensure

13. DEA Registration (if applicable to position) - https://bit.ly/2BNXFCi

14. Collaborative Practice Agreement (required) - https://bit.ly/2QzGBID 

A mutual agreement between the physician(s) and the ARNP

Collaborative Practice Agreement, must include...

     A. A description of the duties of the ARNP
     B. A description of the duties of the physician
     C. The management areas for which the ARNP is responsible, including:
          1. The conditions for which therapies may be initiated
          2. The treatments that may be initiated by the ARNP
          3. The drug therapies that the ARNP may prescribe, initiate, monitor, alter or order
     D. A provision for annual review by the parties
     E. Conditions and a procedure for identifying conditions that require direct evaluation

Disclaimer: I work in Florida, this is my experience. Your process could be slightly different.