What is the Credentialing Process for Nurse Practitioners?

Jun 22, 2021 | Credentialing, Verification

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Every healthcare provider within a healthcare delivery organization must be initially credentialed then re-credentialed every three years in order to practice, retain privileges, and submit for reimbursement. When a healthcare organization hires licensed and certified nurse practitioners, the medical staff services team or an independent credentials verification organization (CVO) conducts the credentialing process.

Credentialing is a process through which healthcare organizations verify providers’ education, training, certifications, and licensure. They also search for any disciplinary actions or sanctions against the provider. A medical staff services department must be familiar with hundreds of healthcare taxonomies to properly follow the credentialing processes for each member of their medical staff. In nursing alone, there are over 183 different certifications.

The following is a list of steps that an employer or an educational institution can share with nurse practitioner applicants or graduates to help them navigate the certification and credentialing process. Keep in mind that these general steps typically vary by state.

9 Steps to Attaining Nurse Practitioner Credentials

After an individual completes a two- to four-year Registered Nurse (RN) program with licensure, RN credentialing, and practicum, he/she must also attain a master’s or doctoral degree from a recognized educational institution to become a nurse practitioner. But education isn’t the final step; licensure and credentialing are also necessary. To receive nurse practitioner credentials, applicants should take the following nine steps:

  1. Choose a certification board and apply

Board certification validates a nurse practitioner’s education, knowledge, expertise in a given area of practice, and skills as a care provider. Board certification exams are administered by the American Academy of Nurse Practitioners (AANP) or through the American Nurses Credentialing Center (ANCC), among other board certifications. Each board certification charges application fees. The AANP costs $315 for initial certification but provides a $75 discount to AANP members for a $240 certification. For the ANCC, non-members are required to pay $395 and members pay $340. Additional discounts exist for student members ($290) and ANA members ($270).

  1. Send credentialing information for verification

Send an official transcript of completed education from a recognized educational institution to the certification board of choice. Certification boards to choose from include (but are not limited to) the American Nurses Credentialing Center (ANCC), the American Academy of Nurse Practitioners (AANP), the American Association of Critical Care Nurses (ACCN), and the Pediatric Nursing Certification Board (PNCB). This process usually takes three to six weeks.

  1. Take the exam

Once the submitted information has been verified, the applicant is emailed an authorization/eligibility to test and a date and location for the test. The testing is rigorous. For example, the AANP examination has 150 questions and allows 180 minutes while the ANCC examination has 200 questions and allows 240 minutes. Both require two forms of identification (one of which must be a photo ID while the other may be a debit/credit card with a signature on the back). Preliminary results will be available immediately upon completion.

  1. Receive official certification

Official certification takes two to three weeks to process. The certificate is mailed, and the respective website will list the award of certification.

  1. Apply for nurse practitioner licensure with the state Board of Nursing (BON)

Nurse practitioner credentials requirements vary by state and guidelines are available on each state’s board of nursing (BON) website. Review the application carefully as mistakes can cause delays in the process.

Required documents include:

  • A passport-style photo
  • Completed application
  • Copy of birth certificate or US passport (Proof of citizenship)
  • Fingerprints or release to collect previous fingerprints (background checks)
  • Check for fingerprint release (approximately $20)
  • Application Fee (Approximately $100)
  1. Receive licensure from the state BON

This can take from eight to twelve weeks and requires renewal every several years depending on the state.

  1. Apply for a DEA certificate

With a state license, nurse practitioners can prescribe medications. To prescribe controlled substance medications, federal law requires that nurse practitioners obtain a Drug Enforcement Agency (DEA) certificate.

  1. Apply for a Controlled Dangerous Substance certificate

Some states require a Controlled Dangerous Substance (CDS) certificate in addition to a DEA number. The certification will cost $731.

  1. Apply for an NPI number

The National Provider Identifier (NPI), is a ten-digit number that uniquely identifies providers to Medicare and Medicaid for reimbursement and will be received within ten days after application.

Primary Source Verification for Nurse Practitioner Credentialing

When reviewing a nurse practitioner’s application for employment, it is important to understand the applicant’s level of progress with certification, licensure, and the additional substance control certifications. Employers should also verify that all of the paperwork described above has been correctly completed and that the provider is in good standing.

Until the nurse practitioner credentialing process is complete—meaning that each credential is primary source-verified, and additional screening for exclusions, sanctions, debarments, disciplinary actions has been completed—services from that nurse practitioner cannot be reimbursed by an entitlement program without risk of fines, penalties, and repayment of the reimbursement.

For a medical staff services team at a healthcare organization, acquiring primary source verification for all nurse practitioner credentials is time-consuming and can delay privileging and onboarding a much-needed nurse practitioner.

Verisys is an NCQA-certified and URAC-accredited Credentials Verification Organization (CVO) that offers turn-key credentialing of providers and hospital staff. Verisys performs initial license verifications and ongoing monitoring of license status as well as verifying against some 5,000 primary sources to confirm an applicant’s education, specialty certifications, and exclusions, sanctions, or debarments. This comprehensive process is one of the most important steps to hiring competent nurse practitioners and assuring ongoing compliance.

With its proprietary data set, FACIS® assures access to real-time verified data on exclusions, sanctions, debarments, and disciplinary actions. It also guarantees continued compliance with regulatory and healthcare industry-standard requirements so that healthcare professionals can be secure in their compliance and focus on providing quality care.

Susen Sawatzki Written by Susen Sawatzki
Healthcare Industry Expert
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