02 — Capability · BC-1850.40
Credentialing & Privileging
Confirm that every physician and advanced practitioner is licensed, trained and fit to practice before they treat patients, grant privileges that match proven competence, and recheck both on a set cycle. Hiring employees and enrolling clinicians with payers are owned elsewhere.
- Medical Staff Services
- Medical Staff Credentialing
- Clinical Privileging
In scope
- Primary source verification of licenses, education, training and certification
- Privilege delineation and committee approval
- Reappointment and professional practice evaluation
- Medical staff bylaws, rules and committee support
Out of scope
- Recruiting and pre-employment checks for employees (see BC-320.30)
- Enrolling clinicians with payers so their claims are paid (see BC-1840.60)
- Health plan credentialing of network providers (see BC-1870.30)
- Mandatory training and certification tracking for staff (see BC-330.50)
Decomposes into · 5
- BC-1850.40.10Primary Source VerificationVerify each practitioner's licenses, education, training, certification, sanctions and malpractice history directly with the issuing source.
- BC-1850.40.20Clinical Privilege DelineationDefine what each practitioner may do in the organization from proven training and competence, and take every request through committee approval.
- BC-1850.40.30Practitioner ReappointmentRecredential and reappoint practitioners on a fixed cycle, refreshing each verification and reviewing performance before privileges are renewed.
- BC-1850.40.40Professional Practice EvaluationEvaluate new practitioners closely for a focused period and all practitioners on an ongoing basis, and act on any concern raised.
- BC-1850.40.50Medical Staff GovernanceKeep the medical staff bylaws, rules and committees running, and record every credentialing and privileging decision they make.