Credentialing for Nurse Practitioner (2022): What You Should Know

Whether you are studying to become a nurse practitioner or already working in the profession, it is never a bad idea to brush up on the best practices involved in credentialing. Health care organizations also play a massive role in the credentialing process for nurse practitioners.

Every nurse practitioner must be initially credentialed and re-credentialed to practice healthcare, bill, and renew privileges every three years (depending on the state). 

The medical service team within a healthcare organization or an independent credentials verification organization must deal with conducting the credentialing process.

This article will learn everything you need to know about becoming a credentialed nurse practitioner.

What Is Nurse Practitioner Credentialing? 

Nurse Practitioner credentialing is a process that healthcare organizations use to verify NP's licenses, training, certifications, and education. Credentialing also requires the organization to search for past disciplinary sanctions against the practitioner. 

The healthcare organization's medical staff service department must be familiar with the numerous healthcare taxonomy to effectively follow the credentialing process of every medical staff in the organization. There are over 180 different certifications in nursing alone. 

You should also note that being a  certified nurse practitioner is possible without being credentialed. Healthcare certification gives you the official approval to operate legally or professionally in specific capacities or carry out certain specialized procedures. Getting certified means you have passed your board's professional examination. 

On the other hand, Credentialing is a system used by organizations (e.g., Medicare, Medicaid, Blue Cross, etc.) to confirm that their providers (nurse practitioners inclusive) meet all requirements and are duly qualified. 

In summary, certification is one of the steps involved in credentialing, as credentialing has a much broader scope. 

Steps Involved In Nurse Practitioner Credentialing 

Healthcare organizations and nurse practitioners have roles to play in credentialing, as we will see in a bit. 

After completing your 2-4 year Registered Nurse (RN) program and obtaining your license, practicum, and RN credentialing, you must obtain a degree from a recognized institution to become a certified nurse practitioner. However, education is hardly the only step needed to get credentialed.

To get involved in credentialing, you need to take the following steps.

Apply for Board Certification

You should apply for board certifications to validate your knowledge, education, and expertise as a nurse practitioner. For nurses, board certification examinations are administered by the American Nurses Credentialing Center (ANCC) or the American Academy of Nurse Practitioners (AANP).

Today, the ANCC Exams cost $395 and $340 for non-members and members, respectively, while the AANP costs $315 for non-members with $240 for members.

Send Your Credentialing Information for Verification

After application to your chosen board, you need to send an official transcript of your completed education from your recognized educational institution to the certification board of your choosing. This process can take between 3 to 6 weeks. 

Take your board Exams and get officially certified 

After the board has verified your information, you will receive a notification via email of your eligibility for testing. You will also receive a date and location for your test. The test can be a rigorous and extensive process. 

For instance, in the ANCC examinations, you are given about 200 questions to be answered in 240 minutes, while in AANP exams, you need to answer 200 questions in 240 minutes. 

Both examinations require you to come with two forms of identification; your photo ID and a debit/credit card duly signed at the back. The test results would be available immediately upon completion of the test.

On successful completion of the examinations, an official certification might take 2-3 weeks to be processed. The certificate will arrive at, and the respective website will duly list the certification award. 

Apply for nurse practitioner licensure with the state Board of Nursing (BON)

When you have obtained your Federal board certification, you must process your state license. The required credentials might vary by state. However, application guidelines are available on each state's Board of Nursing (BON) website. Carefully review your application to avoid unnecessary delays. 

Some required documents are;

•  A completed application
• US passport or a copy of your birth certificate 
•  Passport format photo
• Release to collect previous fingerprints for background checks 
• Application Fee (Approximately $100) 

It might take about 8-12 weeks to receive licensure from the state BON. This license requires renewal (the renewal duration depends on the state).

Apply for DEA Certificate And Controlled Dangerous Substance (CDS) Certificate 

Having a state license means you can prescribe medication to patients. However, nurse practitioners must obtain a Drug Enforcement Agency (DEA) certificate according to federal laws. 

In addition to DEA number, some states require a CDS certificate which costs about $730 

National Provider Identity Number 

NPI is a ten-digit number medical and Medicaid uses to uniquely identify healthcare providers for reimbursement. You can get your NPI number within ten days after application. 

Employers role in Nurse Practitioner Credentialing 

When you have done your part, there are various roles your employer has to play in your credentialing process.

The employer's responsibility is to regularize you with the insurance company the bill. 

Your information is collected, processed, and submitted to the major insurance companies they bill on your behalf. This allows them to bill insurance companies for services you render to patients you see. 

To see patients in the hospital, your employer also needs to help you obtain medical staff privileges at the hospital. This is another aspect of credentialing that allows you to see patients under their medical staff by-laws. 

Having a full license (federal and state) or being registered with an insurance company does not guarantee that you can work at a particular hospital. Obtaining medical staff privileges within the hospital, you work with can be lengthy. 

Summary

Getting credentialed might not permanently prohibit you from working within a healthcare organization. 

After licensing and certification, you are legally qualified to work. However, it is impossible to bill for the services you provide to your patients without credentials.

Consequently, your employer may allow you to begin working while they process their end of the credentialing process. During this time, another provider may allow you to charge them.