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What is Credentialing?

Lisa Hernandez
Lisa Hernandez

Credentialing is the process of verifying the qualifications and backgrounds of professionals or organizations. For a professional, this process is generally initiated when he or she seeks employment and submits an application. Verification of credentials is repeated at certain intervals in various fields to ensure that the employee is still qualified to remain in his or her position. The credentials of an organization, such as a healthcare facility or school, might also require verification to ensure that it complies with all regulations. Credentials can include licenses, certifications, educational or experience requirements and accreditation.

The credentialing procedures can vary depending on the profession and can be based on the criteria set by the business or organization or by any applicable laws. Generally, when a professional seeks a position that requires credentialing, he or she is presented with a form that has been designed to gather the data that needs verification. This form might request information regarding the applicant's education, training, experience, licenses and certifications. The employer or organization then seeks to verify the provided information by contacting the sources that granted those credentials.

Many fields require continuing education or training in order for an individual to remain qualified.
Many fields require continuing education or training in order for an individual to remain qualified.

Another form of credentialing occurs when an organization grants a professional a qualification. The credential that is granted to the individual is an indication that he or she has met the standards set by the credentialing body. This credentialing body reviews the individual's achievements and background to determine whether he or she qualifies for the designated credential. The credential can be in the form of a certification or membership in an association. A credential that is awarded to an individual can lend significant recognition and is an indication of an acceptable level of achievement.

Verifying credentials is important to ensure that the predetermined standards of quality set by the employer or organization are met. A set of standards that is consistent is critical. This helps to evaluate each prospective employee of a given profession uniformly. It is also critical to ensure that all professionals in their field possess an acceptable level of competency. Many fields require continuing education or training in order for an individual to remain qualified.

Examples of professions that require credentialing include educators, physicians, attorneys and insurance agents. Additionally, various types of organizations require credentialing to verify that they are meeting the standards for accreditation as well as any legal requirements. These include hospitals and other healthcare facilities, schools and institutions. Establishing that individuals and organizations meet the standards set by their governing bodies ensures a consistent level of quality and professionalism.

Discussion Comments


My aunt has been an administrator at a nursing home for a long time. One advantage to this job is when my grandma was no longer able to stay in her own home, she was able to move into the nursing home where my aunt works.

This way my aunt knows my grandma is getting good care and can keep a close eye on her. Even though this job is rewarding, it also comes with many challenges.

There are many credentials and regulations that must be followed in any kind of healthcare setting. I have heard her refer to a service they use called CAQH credentialing.

This is a service that is paid for to assist her in making sure she has met all the necessary qualifications. Sometimes it may seem expensive to continually pay for a service like this, but when the inspectors and auditors show up, it really makes things a lot less stressful.


My son has been in the insurance business for several years. In order to become a licensed insurance agent, he had to pass a test.

The first exam he took was to sell life insurance. Since that initial test, he has taken many exams to meet other qualifications in the insurance industry.

For every type of insurance product he is licensed to sell, he also needs to complete continued education requirements.

These are usually done as daily seminars where they cover the course work and take the exam all in one day. If he didn't keep current on these credentials, he would no longer be licensed to sell the insurance products without being tested again.

All aspects of the insurance industry are closely regulated. Even though companies may offer different services and benefits, they must all closely adhere to the standards and credentials that are required of them.


Anytime myself or someone in my family goes to the doctor or hospital, I am thankful for the doctor credentials that are required.

Even though there will always be some physicians that are better than others, at least you know there is a standard that needs to be followed in order for them to receive the proper credentials.

Our family always says we don't want the doctor who graduated last from medical school, but in reality, you know someone had to.

When hospitals are looking to hire physicians, I wonder what kind of specific physician credentialing is required for a general practitioner vs a pediatrician.

Since there are some many different kind of doctors, I imagine that each specific field has their own set of credentials. I think there would be more to it than just graduating from medical school.


My daughter's first job while in high school was working at a daycare. She continued to work in a daycare setting even while she was in college.

Between her years of experience and education she was qualified to become a director to run a daycare center in our state.

Once all of the specific credentials were met, she was pretty excited knowing she had met all the qualifications to run a center on her own.

In addition to the staff, the daycare facilities also have to meet certain requirements and regulations. If they accept children whose parents receive any kind of state aid, that is a whole other set of credentials that must be met.


Hair stylists have to keep their credentials current too. My best friend got her cosmetology degree back in 1998, but she has had to attend occasional classes now and then to keep her license active.

This is probably best for both her and her clients. At these classes, stylists are taught the latest trends and techniques in the world of hair and makeup. Without mandatory attendance, many stylists would get stuck in the past and lose clients this way.

My friend always knows what is hot and happening. She knows how to do the most fashionable new hairstyles, and she is quick to tell her clients about the latest trends. They always appreciate the heads up.

Also, if she ever wanted to work in someone else's salon, she would have to present valid credentials. Cosmetologists are strict about the quality of their employees' work, because each worker has a huge impact on the reputation of the salon as a whole.


@lighth0se33 – Medical credentialing has more than one meaning. My cousin is a doctor with a private practice, and when he mentions medical credentialing, he is talking about credentialing from an insurance provider.

Doctors have to receive this credentialing from insurance companies so that they can get paid by them. A patient comes in with an insurance card and only has to pay a small amount of the bill, while the doctor waits for the insurance company to pay the rest.

Doctors always have a sign either on the door of their practice or at the front desk showing what types of insurance they accept. Many doctors accept most major insurance companies, so if you have coverage from a smaller, less known company, you should ask if the doctor takes it before making an appointment.


My sister is working on earning her teaching credentials. She has always wanted to be an elementary school teacher, and now, she is in the process of making that happen.

She has to study multiple subjects to receive an elementary school teaching credential. Schools want their teachers to have a well-rounded education, since many times, elementary school teachers teach more than one subject.

In first and second grade, one teacher taught a class everything. We stayed in her room all day.

It wasn't until fourth grade that we started switching rooms and teachers for different subjects. I'm proud to know that my sister will be one of these multi-talented teachers capable of doing it all.


I am really glad that hospitals and clinics do medical credentialing. I work at the front desk in my local hospital, and a man recently came in to apply for a doctor's position.

On paper, he seemed the ideal candidate. He had all the right degrees and plenty of work experience.

However, when they checked his background, they found that he had been accused multiple times of sexual harassment, and suspicion surrounded him regarding a case at a facility where he had worked in which multiple patients died within a short time frame.

Though he had not actually been convicted of anything, the boss decided that hiring him would not be a wise decision. He didn't want to put patients at risk.

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    • Many fields require continuing education or training in order for an individual to remain qualified.
      By: auremar
      Many fields require continuing education or training in order for an individual to remain qualified.