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Credentialing Glossary

Plain-language definitions of common credentialing, privileging and enrollment acronyms and terms, with links to official sources.

Jump to: A · B · C · D · E · F · I · L · M · N · O · P · R · S · T · U

A

AAPA (American Academy of Physician Associates): National professional society for physician assistants/associates (PAs). Source: AAPA (opens in new tab)
ABMS (American Board of Medical Specialties): Organization of 24 member boards that certify physicians in specialties. Certification can be checked through ABMS Certification Matters. Source: ABMS member boards (opens in new tab) · Certification Matters (opens in new tab)
ACGME (Accreditation Council for Graduate Medical Education): Accredits U.S. residency and fellowship programs. Its public ADS search shows a program's accreditation. Source: ACGME ADS public search (opens in new tab)
ACHC (Accreditation Commission for Health Care): Accrediting organization with a hospital accreditation program. See the Accreditation page. Source: ACHC hospital accreditation (opens in new tab)
AOA (American Osteopathic Association): Professional association for DOs. Its boards certify osteopathic physicians; AOA Profiles report education and training. Source: AOA board certification verification (opens in new tab) · AOA Profiles (opens in new tab)
APP (Advanced practice provider): Common umbrella term (not a legal title) for practitioners such as PAs, NPs, CRNAs and certified nurse midwives.

B

Board certification: Certification by a specialty board that a practitioner met its training and exam requirements. Verify with the certifying board or an accepted equivalent source. Source: ABMS member boards (opens in new tab)

C

CAQH ProView (Now DataSpring ProView): Online profile where practitioners enter and attest application data and documents, then authorize health plans and organizations to view it. Source: ProView (opens in new tab)
CME (Continuing medical education): Education practitioners complete to keep licenses and certifications current. Requirements are set by state boards and certifying boards.
CMS (Centers for Medicare & Medicaid Services): Federal agency that runs Medicare and works with states on Medicaid. It sets the hospital Conditions of Participation. Source: CMS glossary (opens in new tab)
CMS-855I / CMS-855B (Medicare enrollment applications): Paper Medicare enrollment forms: CMS-855I for physicians and non-physician practitioners, CMS-855B for clinics/group practices and certain other suppliers. Reassignments, once on the CMS-855R, are now reported on the CMS-855I. Most enrollment can also be done in PECOS. Source: CMS-855I (opens in new tab) · CMS-855B (opens in new tab) · 855I/855R bulletin (PDF) (opens in new tab)
CoP (Conditions of Participation): Requirements hospitals must meet to take part in Medicare and Medicaid (42 CFR Part 482). Medical staff requirements are at 42 CFR 482.22. Source: 42 CFR 482.22 (opens in new tab)
CPCS / CPMSM / CPES (NAMSS certifications): NAMSS professional certifications: Certified Provider Credentialing Specialist (CPCS), Certified Professional Medical Services Management (CPMSM) and Certified Provider Enrollment Specialist (CPES). Source: NAMSS Certification (opens in new tab)
Credentialing: Collecting and verifying a practitioner's qualifications (license, education, training, experience, competence) to decide on appointment or network participation.
CVO (Credentials verification organization): An organization that performs primary source verification for others. NCQA and URAC offer programs for CVOs. Source: URAC CVO accreditation (opens in new tab) · NCQA credentialing (opens in new tab)

D

DEA registration (Drug Enforcement Administration): Federal registration required to prescribe, dispense or administer controlled substances. Many states also require a state controlled substance registration (CSR/CDS). Source: DEA Diversion Control (opens in new tab)
Delegated credentialing: A health plan lets another organization do some or all credentialing under a written agreement. NCQA holds the delegating organization responsible for oversight. See Delegation. Source: NCQA credentialing (opens in new tab)
Disaster privileges: Privileges granted to volunteer practitioners only when the Emergency Operations Plan is activated (TJC). See Disaster privileges.
DNV (DNV Healthcare (NIAHO)): Accrediting organization whose hospital program is NIAHO. Source: DNV NIAHO (opens in new tab)

E

ECFMG (Educational Commission for Foreign Medical Graduates): Certifies international medical graduates for U.S. graduate medical education and offers a certification verification service. Source: ECFMG CVS (opens in new tab)

F

FCVS (Federation Credentials Verification Service): FSMB service that verifies and stores a physician's core credentials (education, training, exams) for reuse. Source: FSMB FCVS (opens in new tab)
FPPE (Focused professional practice evaluation): Time-limited evaluation of a practitioner's performance, required by TJC for all newly requested privileges and also used when concerns arise. See FPPE and the FPPE date calculator.
FSMB (Federation of State Medical Boards): National organization of state medical boards. Runs DocInfo, the Physician Data Center and FCVS. Source: DocInfo (opens in new tab) · FSMB PDC (opens in new tab)

I

IMLC (Interstate Medical Licensure Compact): Agreement among member states offering an expedited path for qualified physicians to get licenses in multiple states. Source: IMLC (opens in new tab)

L

LEIE (List of Excluded Individuals/Entities): HHS OIG's list of individuals and entities excluded from federal health care programs. See the Exclusion screening center. Source: OIG exclusion search (opens in new tab)

M

MEC (Medical executive committee): Medical staff committee that typically reviews credentials files and recommends appointment and privileges to the governing body. Under 42 CFR 482.22(b), if the medical staff has an executive committee, a majority of its members must be MDs or DOs. Source: 42 CFR 482.22 (opens in new tab)
MSP (Medical services professional): Common term for medical staff office professionals who handle credentialing, privileging and medical staff support. Source: NAMSS (opens in new tab)

N

NAMSS (National Association Medical Staff Services): Professional association for medical staff services and credentialing professionals. Publishes Industry Credentialing Standards and runs NAMSS PASS and the CPCS, CPMSM and CPES certifications. Source: NAMSS (opens in new tab) · Industry Credentialing Standards (PDF) (opens in new tab)
NAMSS PASS (Practitioner Affiliation Sharing Source): NAMSS database of practitioner affiliation and work history data shared by participating organizations. Source: NAMSS PASS (opens in new tab)
NCCPA (National Commission on Certification of Physician Assistants): Certifies PAs (PA-C). Certification can be verified online. Source: Verify PA-C (opens in new tab)
NCQA (National Committee for Quality Assurance): Accredits health plans and offers Credentialing Accreditation and Certification programs. Sets verification time limits (most items 120 days). Source: NCQA credentialing (opens in new tab)
NPDB (National Practitioner Data Bank): Federal repository of malpractice payments and certain adverse actions. Hospitals must query it when granting privileges and at least every 2 years (45 CFR 60.17). Source: NPDB (opens in new tab) · 45 CFR 60.17 (opens in new tab)
NPI (National Provider Identifier): Unique 10-digit identifier for health care providers, issued through NPPES. Source: NPI Registry (opens in new tab)
NPPES (National Plan and Provider Enumeration System): CMS system that issues NPIs and publishes the NPI Registry. Source: NPI Registry (opens in new tab)

O

OIG (HHS Office of Inspector General): Federal office that maintains the LEIE and enforces health care program exclusions. Source: OIG exclusions (opens in new tab)
OPPE (Ongoing professional practice evaluation): Ongoing collection and review of practitioner-specific performance data to decide whether to keep, limit or revoke privileges (TJC). See OPPE.
Opt-out (Medicare): A practitioner's choice not to bill Medicare and to contract privately with Medicare patients. CMS publishes an opt-out dataset. Source: Opt-out affidavits dataset (opens in new tab)

P

PECOS (Provider Enrollment, Chain and Ownership System): CMS's online system for Medicare enrollment, reassignments and revalidation. Source: PECOS (opens in new tab)
Preclusion List: CMS list of providers and prescribers precluded from payment for Medicare Advantage items and services and Part D drugs. Source: CMS Preclusion List (opens in new tab)
Primary source verification (PSV): Verifying a credential directly with the organization that issued it, or with a source your accreditor accepts as equivalent. See the PSV sources page.
Privileges / privileging: Permission to perform specific procedures and patient care services at an organization, based on a review of the practitioner's training, experience and competence. Bylaws must include criteria for granting privileges (42 CFR 482.22(c)). Source: 42 CFR 482.22 (opens in new tab)

R

Reappointment / recredentialing: Periodic re-review of a practitioner's qualifications. CMS recommends at least every 24 months when state law sets no timeframe; TJC allows up to 3 years; NCQA recredentialing is every 3 years. See Recredentialing and the reappointment calculator.
Revalidation (Medicare): Periodic re-confirmation of Medicare enrollment, generally every five years. Source: CMS revalidations (opens in new tab)

S

SAM (System for Award Management): Federal site whose exclusion records (formerly EPLS) are screened for debarred and excluded parties. Source: SAM.gov exclusions (opens in new tab)

T

Telemedicine by proxy: Under 42 CFR 482.22(a)(3)–(4), a hospital may rely on a distant-site hospital's or telemedicine entity's credentialing and privileging decisions under a written agreement. See Telemedicine. Source: 42 CFR 482.22 (opens in new tab)
Temporary privileges: Privileges granted for an important patient care need or a clean pending application. TJC limits them to 120 consecutive days.
TJC (The Joint Commission): Accrediting organization for hospitals and other health care organizations. Its Medical Staff chapter covers credentialing and privileging. Source: The Joint Commission (opens in new tab)

U

URAC: Accrediting organization with a Credentials Verification Organization accreditation program. Source: URAC CVO accreditation (opens in new tab)

Definitions are plain-language summaries, not legal or standards text. Missing a term? Email [email protected].