What is Credentialing? - Fusion Healthcare Staffing

Credentialing is the process through which the qualifications of medical professionals are reviewed and verified. These qualifications include education, training, residency, licensing, certification, background, and employment history. Credentialing healthcare providers limits liabilities, reduces malpractice lawsuits, and ensures patient safety.

In the locum tenens industry, the credentialing process consists of three methods of verification and review: hospital privileging, provider enrollment, and agency credentialing.

Hospital Privileging

While hospital privileging is a facet of credentialing, hospital privileging differs in that it reviews and verifies a provider’s competence rather than their education and training. Hospital privileging involves assessing a provider’s scope and quality of patient care services and evaluating their clinical performance.

Hospital privileging is typically handled by a Medical Staff Office (MSO) or Credentials Verification Organization (CVO). Those who work for an MSO or CVO have the responsibility of checking a provider’s background, work history, and peer references.

While the name of this process suggests it is only associated with hospitals, hospital privileging can include privileging at other healthcare facilities, such as surgical centers, clinics, and long-term care facilities.

Provider Enrollment

Provider enrollment is the process through which healthcare providers request participation in a health insurance network. To do this, a provider must be credentialed, provide the necessary documentation, and sign a contract. Provider enrollment also includes the authorization of a provider requesting participation in a public health plan — such as Medicare or Medicaid — and the approval to bill a provider’s organization for the care administered.

Facilities can bill for locum tenens services provided to them in order to offset the cost of coverage. This is typically managed by a billing office and is essential to the long-term sustainability of hiring locum tenens providers. Crucial elements of this component include enrollment in private party insurance payers and/or Medicare and Medicaid, plus the subsequent billing.

Agency Credentialing

Agency credentialing is the review and verification process of a provider performed by the agency they associate with. An agency, like Fusion Healthcare Staffing, assists providers in locating work opportunities. While there are many benefits of working with an agency, one of the most attractive is that agencies will typically cover malpractice insurance. Because Fusion Healthcare Staffing covers malpractice insurance and pairs providers with facilities in need, we perform our own credentialing process.

When it comes to credentialing, Fusion Healthcare Staffing takes the lead in the locum tenens industry. Our experienced credentialing team authorizes providers quickly and meticulously to ensure the providers you hire are qualified for the job. Plus, Fusion Healthcare Staffing is certified with the National Committee for Quality Assurance (NCQA) — our credentialing standard is proven among the very best. We assist facilities with hospital privileging in every way we can, furnish providers with the forms they need, and keep our credentialing database up-to-date. With Fusion Healthcare Staffing, the credentialing process is seamless.


Interested in working with us? Call today at 855-537-8353 and allow one of our experienced recruiters to assist you.

What is Credentialing?