Learn
New to Credentialing? A 90-Day Onboarding Plan
A starter plan for new credentialing and medical staff services staff: what to learn on Day 1, Week 1, and at 30, 60 and 90 days.
How to use this plan. It's a general starting point (general practice), not a requirement from any accreditor. Your organization's bylaws, policies, accreditor and state law come first. Managers can copy it into their own orientation checklist.
On this page: Day 1 · Week 1 · 30 days · 60 days · 90 days · Sources
Day 1: get oriented
Learn the landscape
- Which setting are you in: hospital medical staff, payor/CVO, or office/group enrollment? Start with Quick start for your role.
- Skim the Glossary so terms like PSV, FPPE, NPDB and CAQH aren't new.
- Find out your accreditor (TJC, DNV, ACHC, CIHQ, NCQA, URAC…) on the Accreditation page.
Find your rulebooks
- Get copies of your medical staff bylaws, rules and regulations, and credentialing policy (or, for payors, your credentialing plan).
- Hospitals: read the CMS medical staff Condition of Participation, 42 CFR 482.22 (opens in new tab). It's short and underpins hospital bylaws.
- Ask for access to your credentialing software and the file folders you'll use.
Week 1: learn the file
Shadow a complete file
- Walk through one initial file start to finish with a colleague, using our Initial Credentialing Checklist.
- Learn where each verification comes from on the PSV sources page: license, DEA, board certification, NPDB, OIG LEIE, SAM and NPPES.
- See how files are signed off with the File Approval Form.
Know the clocks
- Verifications go stale: NAMSS recommends 180 days and NCQA uses 120 days for most items. Read Verification time limits and try the aging calculator.
- Hospitals query the NPDB when granting privileges and at least every 2 years (45 CFR 60.17 (opens in new tab)).
30 days: run verifications
Do the work, with review
- Complete verifications on your own files, with a senior colleague reviewing.
- Send requests with our templates: work history, hospital affiliation, medical school, training, malpractice and peer references.
- Use the State directory, Education, Affiliations and Malpractice pages to find contacts.
Screening and red flags
- Learn which exclusion lists you check and how often on the Exclusion screening center; track it with the Exclusion Monitoring Log.
- Learn what to do with gaps, disclosures and adverse findings: Work History Gap Explanation, Attestation Questionnaire and Issue File Notification Sheet.
60 days: privileges, reappointment and enrollment
Privileging and evaluation
- Learn how privileges are delineated and requested: Privileging Request Form Outline and Additional Privileges Department Checklist.
- Understand FPPE, OPPE and temporary privileges on the Accreditation page. Use the FPPE calculator for end dates.
Cycles and enrollment
- Work a reappointment with the Recredentialing Checklist and plan due dates with the reappointment calculator.
- Office and payor staff: learn PECOS, CMS-855 forms, Medicaid and CAQH on Payor enrollment; track with the Provider Enrollment Tracker and Payer Follow-up Log.
90 days: work independently and keep growing
Own the process
- Handle files independently and prepare them for committee.
- Audit your own files against your accreditor's requirements; hospitals on TJC can use the Joint Commission Provider Checklist. Payors that delegate can use the Delegated Credentialing Audit Checklist.
- Read the bylaws sections on appointment, privileges and fair hearing (see Peer review & bylaws).
Build your career
- Join NAMSS (opens in new tab) and your state affiliate; read the NAMSS Industry Credentialing Standards (PDF) (opens in new tab).
- Plan toward a NAMSS certification (opens in new tab) (CPCS, CPMSM or CPES); check NAMSS for eligibility.
- Find podcasts, books and peer groups on Learning, including Career & professional resources.
Sources
- 42 CFR 482.22, Condition of participation: Medical staff (eCFR) (opens in new tab)
- 45 CFR 60.17, hospital NPDB queries (eCFR) (opens in new tab)
- NAMSS (opens in new tab) · NAMSS Industry Credentialing Standards (PDF) (opens in new tab) · NAMSS Certification (opens in new tab)
- Time limits and TJC details: Accreditation page sources.
The day-by-day sequence is a suggested plan (general practice), not a regulatory or accreditation requirement.