The term credentialing is one that newer nurse practitioners may hear and use, but you may not know exactly what it means. What does it mean to be a credentialed nurse practitioner (NP)? Is this the same thing as being board-certified? While the names are similar, being credentialed and being certified are not the same.
Healthcare certification is the process of obtaining, verifying and assessing your qualifications to ensure you can serve as a nurse practitioner. When a student passes their ‘boards,’ or nurse practitioner certification exam, they achieve official certification from the organization that they chose.
Credentialing encompasses a broader scope than certification. According to the National Library of Medicine, credentialing is the process whereby a specific scope and content of patient care services are authorized for a practitioner by a healthcare organization. Credentialing involves verifying a person’s education, licensure, certification and reference checks to establish credibility and competency. Unlike certification, which typically focuses on a specific program or area of expertise, credentialing encompasses a more comprehensive evaluation of an individual's professional profile. For a nurse practitioner to be eligible to bill government agencies and insurance companies, they must be credentialed.
Who Issues Nursing Credentials?
Before you start to worry that you are missing something, take a deep breath! NP students may wonder about the exact order in which these requirements need to be met during their nursing career. Credentialing comes from a few authorized entities:
- Accredited schools can issue educational credentials.
- State or local governments.
- Professional organizations like the American Nurses Credentialing Center (ANCC) issue national certifications that recognize experience and additional education.
- Leadership organizations including the American Academy of Nursing (AAN) issue credentials for awards and honors.
- Employers may credential you in the skills that you are going to perform within their organization.
Before you start your career as an NP, here are some ways that you can prepare to become credentialed.
What Are The Steps to Becoming a Credentialed Nurse Practitioner?
- Graduate as a Nurse Practitioner: The first step to becoming credentialed is earning your degree. This may seem obvious, but first, you must have graduated from an accredited school with a valid nurse practitioner degree. Once you’ve graduated with your MSN, you are prepared to sit for your nurse practitioner boards to become certified.
- Complete Your Boards/Certification Exam: Post-graduation, you must sit for your exams to confirm that you are fully prepared to become a practicing nurse. Once you sit for your exam and are successful, you are issued your official certification. The certification exam is important to become credentialed since it demonstrates to the credentialing bodies that you are recognized as a board-certified nurse practitioner.
- Earn Your State License: Upon completing your degree and passing the certification exam, the next step is to apply for your state nurse practitioner license. Some states refer to this license in different terms, so be sure to refer to the Board of Nursing. Some states lump together the nurse practitioner in the RN license, while others do not. If you are planning to practice in more than one state, you will need a license in every state that you will practice.
- Get Your National Provider Identification Number (NPI): Your NPI is federally issued and adds you to the national list of providers. This is offered through the Center for Medicare and Medicaid (CMS) and ensures you can receive Medicare payment for covered services.
- If You Prescribe Medication, You’ll Need a DEA Number: An NP who administers, prescribes, or dispenses any controlled substance must register with the Federal Drug Enforcement Administration (DEA). You will need to complete the official form to get your DEA number.
The Application Process
Once you have completed the above steps, you are ready to work at most healthcare institutions. From here your workplace will help you complete the process of being formally credentialed. Most healthcare institutions employ a two-step application process broken into the pre-application process and the formal application.
Pre-Application
The initial pre-application ensures that the applicant has met the basic qualifications for hire at the institution. The pre-application usually assesses the following:
- Having an unrestricted license
- Any disciplinary actions or sanctions by insurers, hospitals, licensing boards, or professional organizations
- Presence of any criminal history
- Drug screen
- Board certification
- General health status
If there are any outstanding issues, the applicant must either submit more material or is denied the formal application.
The Formal Application
Once the pre-application meets the minimum requirements for credentialing, the individual is sent a formal application. During the final application, the following are usually evaluated:
- Acknowledgment of receipt of the hospital bylaws, regulations, rules, and the Code of Conduct.
- Information about your current health status and vaccination.
- Submission to a mental and/or physical exam as required by the institution, if there is a need.
- An agreement that all the evidence, information, and diplomas are valid and complete.
Once you have completed these above steps, you have done everything you need to be credentialed! Your privileges will be reviewed every 2 years.
Credentialing can often feel like navigating a maze. At Herzing University, our seasoned professionals are well-versed in state and insurance regulations and ready to shepherd you through the journey. We'll handle each step, ensuring you sidestep any nurse practitioner credentialing pitfalls that could divert your attention from delivering top-notch patient care.
Learn More About Our MSN Programs
* Bureau of Labor Statistics (BLS), U.S. Department of Labor, Occupational Employment and Wage Statistics 2023 / Occupational Outlook Handbook 2022. BLS estimates do not represent entry-level wages and/or salaries. Multiple factors, including prior experience, age, geography market in which you want to work and degree field, will affect career outcomes and earnings. Herzing neither represents that its graduates will earn the average salaries calculated by BLS for a particular job nor guarantees that graduation from its program will result in a job, promotion, salary increase or other career growth.
