Credentialing is a term that usually encompasses two separate processes: credentialing and privileging.
Credentialing: Primary source verification of a health care practitioner’s education, training, work experience, license, etc. A variety of resources are used to verify the information involving direct communication from the educational and training institutions, past and current hospital affiliations and employers, peer reference letters, certification boards, licensing agencies and other sources.
Privileging: Granting approval for an individual to perform a specific procedure or specific set of privileges based on documented competence in the specialty in which privileges are requested.
Each individual working in the hospital or clinic setting must be either: 1) credentialed through a Fairview medical staff process; or 2) employed by Fairview through a Human Resources process. Therefore, an individual must be credentialed, if not employed by Fairview.
Practitioners who are independently responsible for patient care by virtue of their license and hospital authority must be credentialed even if they are employed by Fairview. Licensed independent practitioners who must be credentialed regardless of whether they are Fairview employees or not are physicians, dentists, certified nurse midwives, podiatrists, nurse practitioners, physician assistants and psychologists.
Fairview, like other health care organizations, is legally responsible for knowing that individuals providing patient care are qualified and competent to do so. Over the past 30 years there have been multiple legal cases where hospitals were held accountable because they had not done adequate credentialing.
The Joint Commission, The Centers for Medicare and Medicaid Services (CMS), National Committee on Quality Assurance (NCQA), Minnesota Department of Health and Human Services and other oversight organizations require that members of the medical and allied health staff be credentialed and privileged before working in the facility.
Can a physician or other practitioner work before completing the credentialing process?
No. It is Fairview’s legal obligation to ensure that all practitioners have gone through the credentialing process and have been approved by the Board of Directors to work at a Fairview entity.
A practitioner working at a Fairview entity before the credentialing process is complete places Fairview and the practitioner at legal risk and can directly impact Fairview’s accreditation status.
Any medical student, resident or fellow who is in a training program affiliated with Fairview can work in the facility without being credentialed as long as their practice does not fall outside the scope of their current training program.
Physicians in training who wish to moonlight outside of their residency or fellowship program must be credentialed. For example, a Cardiology fellow who plans to moonlight as an internist must be credentialed for internal medicine privileges.
For information on the online credentialing application, privilege forms and application checklist, see How to Submit an Application.
Initial applications require a fee of $200. Payment may be made by check or credit card and must be received by the Fairview System Credentialing Office before the application is processed. The Application Fee Payment Form is included in the Initial Credentialing Application Packet, see How to Submit an Application.
The Joint Commission is an accrediting organization with a mission to improve the safety and quality of care provided to the public.
Hospitals voluntarily submit to The Joint Commission accreditation surveys every three years; the survey is a comprehensive evaluation of the overall quality and safety of the organization.Fairview System Credentialing Office complies with all of The Joint Commission credentialing standards.
National Committee for Quality Assurance (NCQA) is an accrediting organization for managed care organizations.
Fairview System Credentialing Office must comply with NCQA credentialing standards as a condition of our delegated credentialing contracts with health plans.
Fairview System Credentialing Office is a Credentials Verification Organization (CVO) fully certified by NCQA for 10 out of 10 verification services.
Most health care organizations advise submitting an application 90 days before a practitioner’s start date.
The average processing time is less than 90 days. Ninety days is a benchmark because it allows extra time when verification sources do not respond in a timely manner or clarification of discrepancies is required.
Credentialing consists of two steps: 1) verification process performed by the Fairview System Credentialing Office; and 2) review of the verified application by the Fairview entity’s Medical Staff and approval by the entity’s Board of Directors (entity = hospital, clinic, or other contracted entity).
An application can be completed in less time if peer references and other verification sources promptly respond to Fairview’s requests for information, requested documentation is supplied by the applicant in a timely fashion and there are no red flags identified in the application process which requires further investigation.
Offices such as ours that perform primary source verification of credentialing applications have very little control over process time. The process time is affected by verification sources (other hospitals, training programs, peer references, employers, etc.) responding to our requests for information.
The verification process could be done in 2-3 weeks if all sources respond to first requests for information. If a response is not received, credentialing staff execute additional requests to sources. This causes a significant time delay in completing applications.
Yes. Practitioners can greatly influence the length of processing time by contacting their verification sources and asking each source to mail or fax Fairview’s verification requests back as soon as possible.
When we start processing an application, the practitioner and their credentialing contact receive a letter from our office listing of all verification sources from which we require responses. We ask the practitioner or their credentialing contact to call the sources to prompt responses back to Fairview. Responses can be faxed to our office at 612-672-4123.
Fairview only processes complete applications.
All incomplete applications are returned to the practitioner or clinic for completion; this creates a substantial delay in the practitioner credentialing process.
Use the Initial Application Checklist as a guide to identify what forms need to be submitted. See How to Submit an Application for detailed information.
PSV is the process of verifying credentials directly with the source. For example, a credentialing office cannot accept a copy of a medical school degree as evidence that the physician graduated from medical school. The school must be contacted directly to verify the physician’s attendance and graduation.
PSV is required so that hospitals and credentialing offices do not receive fraudulent documents from applicants or other non-primary sources.
A credentialing office cannot accept any verifications that come through a third party rather than the primary source.PSV is a requirement by accrediting bodies as well as the cornerstone of a good credentialing process.
The Joint Commission accreditation standards require hospitals have privilege forms that indicate the type of care, treatment and services, or procedures that a practitioner will be authorized to perform.
Upon applying for initial appointment or reappointment, practitioners complete a privilege form indicating what privileges or procedures they want to perform at Fairview entity(ies).
Fairview’s privilege forms include two types of privileges: (1) Core privileges are those privileges that are routinely taught in most residency programs. Practitioners that meet the threshold criteria for the specialty are qualified to request core privileges; (2) Special Request privileges are procedures that require additional training or special competence. Additional documentation is required to demonstrate competence within the past two years.
Physicians within each specialty develop the system-wide privilege forms. For example, a group of family medicine physicians review and make recommendations on the Family Medicine privilege form, cardiologists review and make recommendations on the Cardiac Services form, etc.
At Fairview, all privilege form revisions are reviewed by a task force of specialty physicians from each entity in the system. Each entity’s Credentials Committee then reviews the proposed revisions and forwards recommendations to the System Credentialing Policy Committee, which approves all privilege forms for the Fairview system.
See Fairview's Privileging Principles for more information.
No. Fairview Health Services has system-wide privilege forms by specialty listing each entity on the form. Practitioners check the entity(ies) where they are requesting privileges.
The Joint Commission accreditation standards require that hospitals determine a practitioner’s current competency at reappointment.Fairview’s privilege form format identifies special request privileges as those that require additional documentation of competence.
Documentation criteria and privilege forms are established by the medical staff.
To obtain a case list of procedures performed at any of the Fairview Hospitals, you can request this by emailing Jim Essler.
Reappointment is the process of re-evaluating a practitioner’s current competency after they have been appointed to the medical staff or professional staff at a Fairview entity.
If a practitioner does not complete reappointment paperwork on time, the practitioner’s reappointment will expire and they can no longer work or see patients in a Fairview entity.
If a practitioner’s reappointment expires, the practitioner must complete the initial application process in order to be appointed to the medical or professional staff and to treat patients at a Fairview entity.
At Fairview, expirables include a practitioner's:
See Expirables for detailed information.