Have you heard this word over and over but are not quite sure what the heck it means? You’re not alone! Everyone seems to expect NP students and new nurse practitioners to understand credentialing, but few actually do. Let me break down the basics of credentialing, and specifically show you what YOU are responsible for versus what your EMPLOYER is responsible for!
Take a deep breath, I got you!
In this video, you’ll learn:
- The actual definition of credentialing for nurse practitioners
- What credentialing allows you to do as an NP
- What you are responsible for, and the timeline you should be following
- The employer side of the credentialing process, and how it affects your start date timeline!
Keep scrolling if you prefer to read all about credentialing in this overview of credentialing for NPs.
What Is NP Credentialing?
We’re going to start with the basis today, because I feel like the term credentialing is one that we hear and use a lot. But as a newer nurse practitioner, or an NP student, you may not know exactly what that means.
I’m going to break it down for you in some super easy to understand terms and steps, so by the end of this article you’ll have a better idea of what’s going on and what you need to do next, as a new NP. And if you want to have something in your back pocket to reference when this question comes up again, download my NP credential cheat sheet.
So what is credentialing? As a big term credentialing is essentially you becoming legitimate as a nurse practitioner. In order to complete your credentialing process, theres a set of things that you are responsible for as an individual. And your employer handles another set of credentialing steps. We’ll get to that in a little bit, but first, I’m going to start with the things that you need to be doing in order for you to be credentialed.
What Are The Different Elements of NP Credentialing?
First things first on the credentialing checklist is: graduating nurse practitioner school!
Yes, this may seem obvious, but I get a lot of questions from NP students and new grad NPs about the exact order of operations that things need to occur, before, during, and after NP graduation. I cover the full graduation timeline in this blog post. So yes, first you need to have gone to NP school. You’ve graduated with either your MSN or your DNP, essentially giving you the education and the permission to sit for your nurse practitioner boards.
So that first element of credentialing, I guess you could say is your diploma or your transcript.
But the second thing that’s just as important, maybe even more so are your boards.
If you are in NP school, you are in a particular tract, and you’re being prepared to sit for a particular board exam. And once you sit for those boards, and graduate, or pass them, and you are issued your official certification. This is really the first major checkbox towards being credentialed. So that’s saying that you’ve been issued a board certification, and by the credentialing bodies you are recognized as a board certified nurse practitioner.
It may be helpful to think about each element of credentialing as an umbrella. Board certifications are at the national level. There’s nothing state specific about board certifications. Everybody regardless of what state you you live in, if you’re in the US, you are taking tests that are through a particular credentialing body. And whether you’re in New York or California, if you are an FNP, you’re taking one of two NP exams.
The next element of credentialing is your state license.
Once you have graduated and taken your boards, you can apply for your state nurse practitioner license. Now some states are different and have referred to them differently. So some states call it the APRN or the advanced practice nurse, advanced practice registered nurse license. And that’s an umbrella term because while I’m saying “nurse practitioners”, really I should recognize that our colleagues who are certified nurse midwives and certified registered nurse anesthetists all fall under this advanced practice nursing umbrella.
So from a state perspective, this element of credentialing is going to vary state to state. You should refer to your Board of Nursing and figure out what your state recognizes you as, in terms of your license.
Here in New York, I’m an APRN, whereas when I worked in Ohio, I had a CNP, or certified nurse practitioner license. Which is why this step is important to refer to your Board of Nursing. Some states lump together the nurse practitioner in the RN license, some states don’t. And also some places you like California, for example, you have to apply for an additional registration number to be able to prescribe. So this credentialing step happens at the state level and refers to your license.
Another part of your credentialing that you’re often responsible for is your National Provider identification number or NPI.
Your NPI is something that’s federally issued and adds you to the national list of providers, like physicians, advanced practice providers, etc. This element of your credentialing process is something that’s governed through CMS, which is the Center for Medicare and Medicaid, and is really an insurance thing.
So if you are working in a cash pay clinic, then technically yes, you can practice without this. But chances are you will be working in a medical setting that bills insurance. And if so, you’ll need to get your NPI number and provide it to your employer so that when they do their end of credentialing, they have your registration number.
If you plan to prescribe, you’ll require another federally issued license: you DEA number.
The DEA stands for Drug Enforcement Administration, and this element of credentialing is confirming your permission to prescribe scheduled substances, narcotics, etc. If this is going to be part of your practice, then you will want to get this license. And if your employer offers to pay for this, this is great news! Because right now, as of 2020, it’s $731 for a three year license. So it’s something that you will likely need most providers, most NPS do need this, but there’s an off chance that your employer may pay for it, in which case, if you’re a new grad, and you know that your employer is going to pay for it, you can plan to have that reimbursed,.
If you end up doing this process on your own, the good ness is that it can be done completely online.
Okay, so that sums up the credentialing steps that you will be responsible for as a graduating NP. You will:
- Graduate from NP school
- Sit for your boards (and get a certification when you pass!)
- Apply for your state license
- Then for your NPI number
- And possibly apply for your DEA license.
What Parts of Credentialing Will My Employer Handle?
Now, your employer hands another side of credentialing. So these are steps they do for you, more often than not.
The first process they’ll handle is to essentially make you legitimate nurse practitioner insurance companies.
What an employer will do on your behalf is they will identify all of the documents they need from you, and submit all this information to the major insurance companies that they bill under. That way, when you see patients, they can collect money for the patients that you see, because you’re a registered provider with that insurance company. So that’s the first major thing that happens with the employer side of credentialing.
The employer side of credentialing also includes registering you with their malpractice insurance.
This should also be a conversation that you have with your employer. Do they provide malpractice insurance? Is that a benefit of your employment? And what do you need to do in addition to the malpractice insurance that they provide?
If you’re going to be seeing patients in a hospital, another aspect of the employer side of credentialing is helping you obtain medical staff privileges at the hospital.
Even though you have your license, your certification, and you’re registered with the different insurance companies, each hospital also has a process for making you a recognized provider in that hospital. This allows you to see patients under the terms of their medical staff bylaws. Be warned, that this can be a long process. Even if you are already licensed as an NP. Even if you are switching jobs in the same state, and you’re already registered with all these insurance companies, this can be a lengthy process.
It’s helpful to know what’s going on behind the scenes with your employer. This way, you’re not surprised if or when the credentialing process can often be lengthy.
Can I Start Working Before Being Credentialed?
Something to note is that not being credentialed doesn’t always prohibit you from working. You can legally work as a nurse practitioner after licensing and certification. However, you may not be able to bill. Here’s how this could play out. Let’s say you have a planned orientation period that’s one or two months. It’s possible that your employer may have you start even if the employer side of credentialing is not yet complete! Because you’re allowed to work as an NP, and you may bill under a different provider during orientation.
Phew. I hope that clears things up about what credentialing is for NPs. And makes you more comfortable with your specific responsibilities.
Now that you have a better understanding of credentialing, download my free Nurse Practitioner Graduation Survival Kit. This includes an outline and glossary of all the different nurse practitioner credentialing elements we’ve discussed today. And a timeline of what you should be doing in each month before, during, and after graduation!