5 Best Practices for Successful Clinician Credentialing
June 2025

In today’s fast-paced healthcare environment, efficient and accurate clinician credentialing is essential—not only for regulatory compliance but also for operational efficiency and patient safety. A well-structured credentialing process ensures that healthcare professionals meet all necessary qualifications and are properly vetted before providing patient care. Below are five best practices to help healthcare organizations and credentialing professionals streamline and improve their clinician credentialing process.

1. Centralize and Standardize Credentialing Information

Fragmented data storage can lead to delays and errors in credentialing. Centralizing clinician information in a secure, cloud-based platform allows credentialing specialists to easily access, update, and verify key documents like licenses, certifications, and malpractice history.

Best Tip: Use credentialing management software that offers document tracking, automated reminders for renewals, and audit-ready reporting.

2. Establish a Clear, Repeatable Credentialing Workflow

A standardized workflow helps reduce variability, improves consistency, and ensures that every clinician undergoes the same rigorous credentialing process. Map out each step from application intake to primary source verification and committee review.

Best Tip: Create checklists for each stage of the process to ensure nothing is missed, and use a credentialing dashboard to monitor progress in real-time.

3. Stay Compliant with Changing Regulations

Credentialing must align with federal, state, and payer-specific requirements, which are frequently updated. Staying informed and compliant is critical to avoid delays in payer enrollment and risk exposure.

Best Tip: Assign a compliance officer or credentialing lead to monitor updates from CMS, state medical boards, and accrediting bodies like The Joint Commission and NCQA.

4. Integrate Credentialing with Scheduling and Billing Systems

When credentialing is siloed from other departments, it can cause delays in clinician onboarding and lost revenue from ineligible billing. Integrating credentialing data with scheduling and revenue cycle systems ensures clinicians are cleared to work—and bill—faster.

Best Tip: Automate data-sharing between credentialing, HR, and billing systems to reduce manual entry and improve accuracy.

5. Track Expirables and Set Proactive Renewal Alerts

A common pitfall is letting licenses, DEA numbers, and insurance credentials expire without timely renewal, which can halt a clinician’s ability to provide services. Implementing an expirables tracking system is essential.

Best Tip: Set up automated alerts 90, 60, and 30 days before expiration to prompt renewals and ensure continuous compliance.

Final Thoughts

Credentialing may be a complex and time-consuming process, but by applying these five best practices, healthcare organizations can significantly reduce risks, improve onboarding efficiency, and enhance operational integrity. In today’s healthcare landscape, streamlined credentialing isn’t just a compliance necessity—it’s a strategic advantage.

If your organization needs support with clinician credentialing, our team is here to help. Contact us to learn how we can optimize your credentialing operations with best-in-class tools and expertise.

The Impact of COVID-19 on Healthcare Credentialing and Licensure

January 1, 2021

The medical profession is justifiably known for rising to a crisis, and the response to COVID-19 is no different. Every day, tireless professionals on the front lines are providing outstanding patient care while creating on-the-spot workarounds for equipment shortages and other issues.

That same can-do spirit is also fully present in the profession’s support teams, who are streamlining processes and reinventing systems in order to deploy caregivers as quickly as possible to where they are most needed. One result is that the credentialing and licensure process looks very different now than it did just a few weeks ago, “One of the greatest challenges now is making sure that you have the right physicians and other healthcare professionals ready to deal with the care that’s needed. “If you are a health system, that may involve putting procedures in place for moving people around within your system. If you are a freestanding hospital, you may need to provide emergency privileges to care providers who have not been part of your healthcare organization in the past.”

“In the face of this pandemic, it’s pretty clear that everyone’s facing a workforce challenge,” “And not just privileged practitioners, but all kinds of healthcare clinicians and non-clinicians are in short supply in certain localities. We’re worried in particular about privileged practitioners in some key areas: hospitalists, for example, intensivists, pulmonologists who can help manage ventilators and respiratory therapists. These are some of the areas where it is anticipated that the needs will be most acute, and there are pools of retired practitioners and part time practitioners, who are not necessarily doing today what they have done in the past, that can be accessed to try and bolster the workforce.”

Onboarding these practitioners as rapidly as possible is a heavy lift, but it has been made somewhat easier by the ground-breaking changes that have come as result of the National Emergency declaration on March 13, 2020 :

Certain requirements with regards to background checks and other kinds of requirements to vet providers to enroll them in Medicare are waived. There are two types of these “blanket” waivers:
Provider Locations. CMS has waived requirements that out-of-state providers be licensed in the state where they are providing services when they are licensed in another state.
Enrollment in Medicare. CMS is allowing new, non-certified Part B suppliers, physicians, and non-physician providers to expeditiously obtain temporary Medicare billing privileges. CMS is also waiving certain application fees, criminal background checks, and site visits with respect to provider enrollment