Credentialing and Privileging - Physician Contract Glossary

Credentialing and Privileging

Definition

A process through which hospitals or insurance plans verify a physician’s qualifications and authorize them to provide services.

Examples in Context

“Physician's employment commencement date is contingent upon successful completion of all credentialing requirements with the hospital and major insurers.”

“The Employer will assist the Physician in obtaining medical staff privileges and completing the credentialing process.”

“Failure to complete credentialing within 90 days may delay the Physician’s ability to begin clinical services.”

Implications for Physicians

• Delays in credentialing may postpone your start date and income.
• Ensures your qualifications are recognized for hospital privileges and insurance billing.
• Errors in credentialing paperwork can result in denied claims.

Negotiation Tips

• Request employer assistance in handling paperwork and fees.
• Negotiate a guaranteed salary if credentialing delays are beyond your control.
• Ask for a written timeline and defined steps to ensure credentialing proceeds smoothly.

Red Flags and Pitfalls

• No clear timeline or support for credentialing.
• Contract lacks a backup plan for delayed credentialing.
• Employer requiring you to work before credentialing is complete may expose you to legal and billing risks.

Related Terms

• Commencement Date
• Professional Liability Insurance
• NCQA (National Committee for Quality Assurance)

FAQs

• “How long does credentialing typically take?”
  • Credentialing can take 60–90 days or longer, depending on the organization’s process and your documentation.
• “Can I start seeing patients before credentialing is complete?”
  • While you may be able to see patients, you generally can’t bill insurers for services provided under your name until your credentialing is finalized.
• “What happens if credentialing is delayed?”
  • Delays can postpone your ability to earn income. Ensure your contract outlines backup pay or an adjusted start date in case of unexpected delays.
• “Who pays for credentialing fees?”
  • Some employers will cover these costs. Confirm this during contract negotiations.</li

Legal Disclaimer

The information provided in this glossary is for educational and informational purposes only and should not be construed as legal advice. While we strive to provide accurate and up-to-date information, this content is intended to help physicians better understand common contract terms and does not replace professional legal guidance.

For personalized advice regarding your employment contract or other legal concerns, we strongly recommend consulting with a qualified attorney who specializes in physician employment contracts.

You can find experienced legal professionals through our Physician Contract Lawyer Directory.