Credentialing is the official process of confirming and verifying a healthcare provider’s qualifications to ensure they meet your organization’s standards for clinical practice.
Credentialing answers a fundamental question:
Is this provider qualified to practice medicine or deliver care in our organization?
Credentialing involves validating a wide range of information, including:
Verification is not a one and done activity. Credentials have to be continuously monitored and periodically reviewed to remain compliant with regulatory and accreditation requirements.
While credentialing identifies who a healthcare provider is and what they do, privileging determines what that provider is allowed to do within a specific healthcare institution.
Privileging grants authorization for a doctor, nurse etc. to perform specific procedures or services based on:
Privileges aren’t regulated by a state or national body but instead are granted by a medical staff committee and are tailored to that providers practice.
Although closely related, credentialing and privileging serve different functions:
Credentialing and privileging are key to high quality healthcare and minimizing risk. When done correctly, they help organizations:
Not following these processes or even simple delays can lead to serious consequences, including compliance violations, denied reimbursements, and reputational damage.
Credentialing and privileging are shaped by multiple regulatory and accrediting bodies. While requirements vary, most healthcare organizations must align with standards from:
These organizations expect healthcare providers to maintain their licenses demonstrate ongoing professionalism and keep up with their required trainings (CME).
Recently, accreditation standards have emphasized continuous monitoring, not just spot checks which raise the stakes for accurate documentation and tracking.
While workflows vary by organization, credentialing typically follows a structured process:
1. Application and Documentation
Providers submit credentials, disclosures, and supporting documentation.
2. Primary Source Verification
The organization verifies credentials directly with primary sources, such as licensing boards and training institutions.
3. Review and Approval
Credentialing committees review verified information and make recommendations.
4. Ongoing Monitoring and Recredentialing
Licenses, certifications, and other credentials are monitored for expiration and changes, with recredentialing conducted on a regular cycle.
Privileging builds on credentialing and focuses on clinical authority.
1. Privilege Request
Providers request specific privileges based on training and experience.
2. Competency Evaluation
Committees assess clinical competence using case logs, peer reviews, outcomes data, and education history.
3. Committee Review and Approval
Privileges are granted, modified, or denied based on organizational standards.
4. Ongoing Evaluation
Privileges are periodically reviewed and adjusted as providers’ roles, skills, or organizational needs evolve.
Even well-run hospitals face difficulties managing the compliance work including:
As healthcare organizations combine via mergers they become more complex, and these challenges only get worse.
Technology plays a critical supporting role in modern credentialing and privileging programs, particularly when it comes to education, competency, and documentation.
While healthcare LMS platforms don’t replace credentialing software, they provide essential infrastructure by helping organizations:
Education is a pilar of keeping privileges, especially since guidelines change so frequently as new medicines, technologies and procedures emerge.
OasisLMS Healthcare focused system, is designed to support healthcare organizations that need reliable, scalable learning infrastructure to complement credentialing and privileging efforts.
With OasisLMS, organizations can:
Rather than managing education separately from credentialing workflows, OasisLMS helps bring structure and visibility to a critical piece of the compliance puzzle.
Healthcare organizations that manage these processes well tend to follow a few consistent best practices:
All of these practices help standardize tasks across your organization.
Credentialing and privileging are much more than checking boxes or easy administrative tasks. When done correctly they are essential procedures that protect patients, support clinicians, and uphold the integrity of healthcare organizations.
As regulatory expectations evolve and healthcare delivery becomes more complex, organizations that invest in clear processes, supported by the right technology, will be best positioned to manage risk, ensure compliance, and deliver high-quality care.
Credentialing verifies a healthcare provider’s qualifications, such as education, licensure, and certification. Privileging determines which specific clinical services or procedures that provider is authorized to perform within a particular healthcare organization.
Yes. Credentialing must be completed first to confirm that a provider meets baseline qualifications. Privileging decisions are then made based on verified credentials, demonstrated competence, and organizational needs.
Credentialing typically requires ongoing monitoring and periodic recredentialing, often every two to three years. Privileges are reviewed on a regular cycle and may also be updated based on changes in a provider’s role, performance, or scope of practice.
Credentialing is usually managed by the medical staff office, credentialing specialists, or HR teams, while privileging decisions are made by medical staff leadership or credentialing committees, often with governing board oversight.
Ongoing education, including CME and CE, helps demonstrate continued competency and is often tied to maintaining or expanding clinical privileges. Accurate tracking of educational activities is essential for audits and reappointment reviews.
An LMS does not replace credentialing software, but it plays a key supporting role by tracking required education, documenting CME and CE completion, and providing reports that support credentialing and privileging decisions.
Inadequate processes can lead to compliance violations, patient safety risks, legal exposure, and accreditation challenges. Inconsistent documentation and manual tracking are common sources of error.
Whether managing CME for physicians or supporting member growth, Oasis LMS helps deliver high-impact education efficiently and at scale.
Copyright © 2025 Oasis-LMS. All Rights Reserved.