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What is the Credentialing Process for Nurse Practitioners?

November 3, 2020

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

Credentialing creates a standard by which healthcare organizations, health insurance companies, and in some instances, patients can verify healthcare providers’ education, training, licensure, and learn of any disciplinary actions or sanctions against the provider.

The medical staff services department for a healthcare organization must be familiar with hundreds of healthcare taxonomies in order to properly follow the credentialing processes for each member of the medical staff. In nursing alone, there are some 183 different certifications according to nurse.org. A nurse practitioner is an advanced practice registered nurse (APRN) with a minimum of a master’s degree plus additional training in a specialty area of medicine.

The following is a basic list of steps that an employer or an educational institution can share with applicants or graduates, respectively, to effectively navigate the nurse practitioner certification and nurse credentialing process. These general steps typically apply with variations from state to state.

9 Steps to Attaining Nurse Practitioner Credentials

Once an individual completes a 2 – 4 year Registered Nurse (RN) program with licensure, RN credentialing, and practicum for an additional period of time, the next step is attaining a master’s or doctoral degree over an additional two to three years of education from a recognized educational institution. The following 9 steps should be taken to attain one’s nurse practitioner credentials:

  1. Choose a certification board and apply

Board certification provides a process that 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 issuers of board certification.

  1. Send credentials information for verification

Send an official transcript of completion of education from a recognized educational institution for verification to the certification board of choice. This process usually takes 3 – 6 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. As examples, 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. Preliminary results are available immediately upon completion.

  1. Receive official certification

Official certification takes 2 – 3 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 from state to state and guidelines are available on each state’s BON website. Review the application carefully as mistakes can cause delays in the process.

  1. Receive licensure from the state BON

This can take from 8 – 12 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. In order to prescribe controlled substance medications, Federal law requires that nurse practitioners obtain a 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.

  1. Apply for an NPI number

The National Provider Identifier (NPI), is a 10-digit number that uniquely identifies providers to Medicare, Medicaid as well as for other instances.

Primary Source Verification for Nurse Practitioner Credentialing

When reviewing a nurse practitioner’s application for employment, it is important to know where in the process the applicant is with certification, licensure, and the additional substance control certifications and verify with the primary sources that all of the work outlined previously has been correctly completed and filed.

Until the nurse credentialing process is complete—meaning that each credential is primary source verified, and additional screening for exclusions, sanctions, debarments, disciplinary actions, indictments against FACIS—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 on all credentials as well as nurse license verification and status is time-consuming and can often hold up onboarding and granting privileges to a much-needed nurse practitioner.

Verisys is a URAC accredited and NCQA certified 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 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 competence ongoing.

With its proprietary data set, FACIS®, access to real-time verified data on exclusions, sanctions, debarments, and disciplinary actions assures continued compliance with regulatory and healthcare industry-standard requirements designed for the purpose of defining and reinforcing the delivery of quality care to all healthcare consumers.

Susen Sawatzki Written by Susen Sawatzki
Healthcare Industry Expert
Muse. Writer. Publisher. Producer. Creator of Inspiring Narratives.
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