fbpx

The Résumé Rx

Nurse Practitioner Credentialing & Process: What do you actually need?

Amanda Guarniere

Have you heard “nurse practitioner credentialing” 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 nurse practitioner 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 nurse practitioner credentialing
  • 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 nurse practitioner credentialing process, and how it affects your start date timeline!

Speaking of timelines: if you want to get your hands on my free NP Graduation Survival Kitdownload it now!

Keep scrolling if you prefer to read all about credentialing in this overview of credentialing for NPs.

What Is Nurse Practitioner Credentialing?

We’re going to start with the basics today because 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, there’s 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 Nurse Practitioner Credentialing?

First things first on the credentialing checklist: 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, is 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, 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: your 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 from 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 goodness 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:

  1. Graduate from NP school
  2. Sit for your boards (and get a certification when you pass!)
  3. Apply for your state license
  4. Then for your NPI number
  5. 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 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!

 

46 Comments

  1. Karen Kaur

    Amanda, thank you so much for this helpful post. I am in this unique situation as I was also thinking that the only use of NPI number is that the provider needs it for billing health insurance companies. I was also under the impression that once I have my state NP license and board certification, I can legally be allowed to work or at least begin orientation, where billing can be done under another provider until I receive my NPI. However, as my credentialing process moved forward, everything cleared, my start date fixed; after this, my employer told me that they cannot start orienting me until I have NPI number, even though I have met all other requirements as mentioned above. I have applied for NPI number on line, but it has been eight days, still waiting as “pending”. My understanding is this, you may correct me if your understanding differs from mine, “ NPI number is needed for insurance billing purposes for all providers. However, NPI number is also needed for HIPPA privacy act, as providers transmit patient information for consultative purposes between each other ( aside from health insurance billing). Please if you may shed some light on it, I appreciate very much. Karen

    Reply
    • Nadia

      Hi Karen – you (and your employer) are correct that an NPI is needed prior to you seeing patients. It is used for insurance credentialing but also for all HIPAA interactions as you mentioned. I typically recommend that you apply for the NPI as soon as the license is issued. You are correct that your employer may allow you to start and bill under another provider until the insurance credentialing is completed, but yes you’ll need your NPI to start. It shouldn’t take long to be issued – I imagine it should be processed within a week or so, but they certainly could have delays I am not aware of. I hope this helps!

      Nadia
      Team Résumé Rx

      Reply
    • Jackie Nielsen

      Thank you for this helpful information. Does an established NP need to undergo credentialing with each of the the health plans again if they change employers? Or is it once and done?

      Reply
      • Nadia

        Hi Jackie! Yes, with each new employer the credentialing information needs to be updated.

        I hope this helps!

        Nadia
        Team Résumé Rx

        Reply
    • Mei-Lani

      Hi! Thanks for the helpful blog post. I have a NPI number from a previous career. Does it follow me to my NP career? If so, do I apply to edit it? If not, how can I deactivate the NPI?

      Reply
      • Nadia

        Hi Mei-Lani,

        We are actually not 100% on this question. We recommend you look for a FAQ section on the previous job’s website otherwise contact them directly to find out how to proceed.

        Nadia
        Team Résumé Rx

        Reply
  2. Shawne Collins

    Hi I am in the process of credentialing a NP for our practice. The physician is interested in her starting before the credentialing is completed. To bill for this situation, please confirm that I can use the physicians NPI (and not the NP’s)as the rendering provider for billing purposes.

    Reply
    • Nadia

      This post is meant to guide the NP in steps to take to credential themselves and doesn’t cover the process of credentialing with insurance companies. Each state has different guidelines regarding incident-to billing (where encounters can be billed under the physician) so I recommend you search your state + “incident to billing” to see what you find out. Good luck!

      Nadia
      Team Résumé Rx

      Reply
  3. Khanh Tee

    Hi! I’m undergoing the credentialing process for a new position, do I only list the MSN program where I obtained my NP education or do I list all previous bachelor and master programs I completed in life? Lol. Thank you!

    Reply
    • Nadia

      Great question, Khanh! It really depends on the specific application you are filling out. Some institutions want to see a record of all of your higher education, whereas others only want your role-specific education. If you have someone you can ask, I would suggest doing so. Otherwise, you can just decide one way or another (probably including role-specific education) and let them get back to you for clarification if needed.

      Nadia
      Team Résumé Rx

      Reply
    • Beth Sciba

      I have worked for an MD in a private pediatric practice for 3 years and the doctor has never credentialed me or the other NPs that now work there. She co-signs all our charts and we bill under her provider number. Is this legal?

      Reply
      • Nadia

        Hi Bath,
        Yes, this can be totally fine depending on your state as well as whether the MD is physically present in the office, among other requirements. This is referred to as incident-to billing. The reason for doing this is so that she captures 100% of reimbursement – Medicare only reimburses 85% for NP services in most states. However, there are strict requirements for incident-to billing so it’s best to do a bit of research to make sure all those requirements are being met. There has been a lot of opposition to this practice from NP and PA organizations, so it’s something that could change in the future. This is a good summary article:

        Nadia
        Team Résumé Rx

        Reply
  4. Mary

    Hello,
    Can you tell me if I can apply for NPI if I have my APRN license but not the CSR approved? I can’t seem to find the answer anywhere.

    Thank you!

    Reply
    • Nadia

      Hi Mary! Yes, you should be able to! You can’t apply for the DEA yet though. Head to the NPI website and go through the application – I think you’ll find it’s pretty quick and easy.

      Nadia
      Team Résumé Rx

      Reply
  5. Shawnee Murray

    Hi!

    Thanks so much for all your videos. Can you tell us a little about the PECOS process? Is this something we need to enroll in ourselves prior to working or is this something your clinic will take care of?

    Thank you!

    Reply
    • Nadia

      Hi Shawnee,

      The PECOS process is how providers enroll in Medicare. It happens after you get your NPI. The NPI is typically your responsibility, and many practices that provide insurance credentialing will often take care of PECOS for you.

      Nadia
      Team Résumé Rx

      Reply
  6. Divaksh Jain

    I’m glad to see that the credentialing process for nurse practitioners is being updated. This will help to ensure that the nurses who are providing care are properly credentialed and qualified.

    Reply
  7. Sarah

    Amanda,
    Your article was very informative in organizing the process of becoming an APN. I am trying to estimate a time-line for how long the entire process will take. I have a date for the ANCC (which hopefully I will pass!) I was told it will take 4-6 weeks after the ANCC to officially get my results. My first question is, do you happen to know, if it takes a full 4-6 weeks for the ANCC results to be sent to the state board of nursing to complete my certification/licensure application? My second question is, on the NJ certification/license application, there is a section that says, ‘if you are not certified, please complete the following..’ and asks for my scheduled test date. It appears to indicate that an APN applicant can submit the application before taking the ANCC. Do you happen to know if this is true? My third question is, can you apply for your certification/license, NPI #, & CDS registration (NJ requirement before obtaining a DEA #) simultaneously? It appears that all of these applications take at least 4-6 weeks to process. I am extremely grateful for any advice you can give me.
    Sincerely,
    Sarah

    Reply
    • Nadia

      Hi Sarah, thanks for your question. I can’t speak to the NJ timeline, but I agree that it appears you can apply for the license in advance of your testing date. The NPI and CDS applications must be done after your license number is issued, so there will be a bit of a wait period there. Hang in there! The process can be tedious but it sounds like you’re staying on top of everything, which is great.

      Nadia
      Team Résumé Rx

      Reply
  8. Jessica Wagner

    Hi! If I am leaving my current employer and switching to a new employer, will the credentialing process have to take place again or once I’m credentialed am I credentialed forever?

    Reply
    • Nadia

      Hi Jessica! Great question. The things that are your responsibility (license, certification, etc) do not need to be changed, except the address on your DEA license. However insurance credentialing needs to be completed and updated with every new employer so that they can bill for your services and collect payment from the insurance companies. Hopefully the employer takes care of that for you!

      Nadia
      Team Résumé Rx

      Reply
  9. ToKamy Alejo

    Thank your for your website site and helpful information. I have the credentials notes you gave down. My question may be elementary, but are we able to work as a “GNP” like we were a “GN” after ADN school? While waiting for boards and credentialing? I do not finish FNP program until December 2023, but wasn’t sure when to start applying for jobs.

    Reply
    • Nadia

      Hi ToKamy! Great question. Unfortunately, the rules are a bit different for NPs and this is not an option in any state that I’m aware of. You will need to have your license issued before you’re able to practice.

      Nadia
      Team Résumé Rx

      Reply
  10. Katie

    Hello,
    I am working in a free clinic. We do not bill insurance or charge the patient at all.
    Do I need to be credentialed with insurance to prescribe meds?
    For example, can I prescribe a medication to a pharmacy without being credentialed with insurance?
    Thank you so much for your response.

    Reply
    • Nadia

      Hi Katie! This is a great question. I don’t believe that you need to be credentialed with insurance to prescribe. You will, however, need the typical licenses including your state license, NPI, DEA license, and any prescriptive authority your state requires.

      Nadia
      Team Résumé Rx

      Reply
  11. Latoya B.

    Hi, I have a npi number as a staff nurse but now that I am a new NP do I need to apply for another npi number?

    Reply
    • Nadia

      Hi Latoya! This is a great question. You may want to check with the NPI organization (NPPES) for a definite answer but I’m pretty sure you can login and change the specifics of your role under your existing NPI.

      Nadia
      Team Résumé Rx

      Reply
  12. jackie

    I’m an established NP and currently work in a group practice. I’m credentialed with several insurances and Medicare. I’m planning on going solo and starting my own practice. It is my understanding I need to get credentialed with the insurance co. again. I’m confused about Medicare? do I complete an initial application or change the existing application ? Also, would you have any recommendations on who I can hire to do my credentialing for me? Thank you for your time. I look forward to hearing from you

    Reply
    • Nadia

      Hi Jackie! Yes, you will need to update all your current contracts to reflect your new practice. You will also likely need to create a group NPI as well. For medicare, you should be able to login to PECOS to change your existing application. Admittedly I don’t have any contacts for credentialing at this time but it IS worth outsourcing this, especially if you are starting your own practice! I do recommend NP Advantage but they are a full service company that also takes care billing and marketing in addition to credentialing. May be worth checking into! https://www.npadvantage.com/

      Nadia
      Team Résumé Rx

      Reply
  13. Jessica Wagner

    Hi! I previously worked for a clinic right after graduation for approximately 8 months and they did all the credentialing for me. I have now left that job and currently work for a school corporation that will be starting a School Based Health Clinic but not partnering with a health care facility. I have found a collaborating physician and was told by her that even though I was fully credentialed through all insurance companies and Medicaid through my last employer, I now have to get re-credentialed. Is this correct? If so, how do I go about doing so? Thank you!

    Reply
    • Nadia

      Hi Jessica,
      Unfortunately…this is correct. If you are going to be billing insurance, you must re-credential every time you have a new employer. It can be very tedious but can be done by yourself. If you have the option, I would recommend hiring a credentialing specialist to do it for you (maybe you can negotiate this to be paid by your employer – it’s customary that the employer takes care of this).

      Nadia
      Team Résumé Rx

      Reply
  14. Nickie

    Amanda,
    Thanks for the info.
    I am in Florida and was wondering if it is ok for another NP that will be only working PRN at the clinic where I am employed to use my insurance credentials to bill?

    Reply
    • Nadia

      Hi Nickie,
      This general is not allowed unless you are the practice owner and have a group contract with an insurance company, in which case sometimes the PRN provider can bill under the group NPI. I would recommend asking each individual insurance company that you have a contract with, since the rules may vary greatly among them. Good luck!

      Nadia
      Team Résumé Rx

      Reply
  15. Lynn Callaway

    Hi Amanda!
    I am an older NP. I graduated from NP school in 1983 and have been working for an Ob-Gyn physicians group for years. I am a Registered Nurse Practitioner and have had over 30 years experience. I have all the requirements to becoming credentialed with the exception of certification. I took my boards back in 1984. Is is possible to be “Grandfathered” in this credentialing process?
    I have an NPI number and work with a collaborative agreement with the docs? If not, what do I need to do to become certified? BCBS does not credential RNP’s. And just recently have taken away my ability to see any and all BCBS patients in our clinic. Is there a possibility of someone in my situation to be Grandfathered into a certified NP? Back in 1983, to become an NP, a BSN was required and that’s what I graduated with. Since then, I have been Practicing as an NP und collaboration with MD’s.

    Reply
    • Nadia

      Hi Lynn! Thanks so much for this great question. Unfortunately, this is a state by state situation. In New York, for example, I know that board certification is not necessary to practice as an NP. So I would recommend directing your question to your state board of nursing and hopefully they can shed some light. I suppose the other option would be going back to school, but I don’t imagine you’d want to do that at this point!

      Nadia
      Team Résumé Rx

      Reply
    • Ann

      I’m in a similar situation. I eventually went on to get a doctorate in my field of psychiatry, but back when I first graduated with a masters, credentialing didn’t exist. In my older years I figured since I have over 30 years of experience and a doctorate, what do I need credentialing for, right? As it turns out, I can’t work independantly because I can’t get on to any insurance pannels. Unless I have a cash practice ( which would never be enough to pay the bills), I need to stay in outpatient psych. until retirement.

      Reply
  16. Caitlin

    I just started at a job as a new NP. It’s a contract position. I have submitted my PECOS application and am working I conjunction with my company on the rest of the credentialing process. I know that if they need me to start before credentialing comes back, there is the incident to billing option, but I am also seeing some things online about potentially retro active billing to Medicare, since they usually put the effective date as the date the application was received. Have you ever heard of this?

    Reply
    • Nadia

      Hi Caitlin!
      Thanks for your question. I’m honestly not familiar with the rules surrounding this specifically for Medicare, but I have heard that this is possible with some payers. Best to ask your Medicare credentialing representative I think!

      Nadia
      Team Résumé Rx

      Reply
  17. Emily Elgin

    Hello Amanda! I have a job prospect that I am really excited about. I have my license and NPI number but not my DEA#. Since the NP I will be replacing will be leaving in 4-6wks after I am hired I wanted to make sure I was able to start the credentialing process ASAP. Is is ok/wise to apply for my DEA even before I get a job to help the process move along faster?

    Reply
    • Nadia

      Hi Emily! I typically recommend waiting until you have a signed job offer before getting the DEA because there’s always a chance that the employer will cover the cost as part of your benefits. Plus, you need to put a practice location on the license itself. That said, if you’re under the impression that you need to have the DEA in order to even secure this job, then it may be wise to get it now. Hope that helps!

      Amanda
      Team Résumé Rx

      Reply
  18. Tazama

    Hi Amanda,
    I want to start my own practice, how do I credential self to insurance companies without hiring someone to do it for me…as I believe I can after getting all my licenses ready??

    Reply
    • Nadia

      Hi Tazama! It’s definitely a lot of work doing it yourself. In hindsight I wish I had hired someone to do it. If you want to do it yourself you definitely need some guidance. I used the self study course from NPBusinessOwner.com called “DIY Credentialing.

      Nadia
      Team Résumé Rx

      Reply
  19. Jesse Ogle

    During initial credentialing that the NP must do on their own varies from state to state. For instance, I am in Idaho and not only did I need state license, NPI, DEA but I also had to apply for a controlled substance prescriptive authority through the board of pharmacy as well as retain a medication monitoring registration. And you ain’t kiddin’ about how long this process is! Call these agencies before you graduate and ask what parts of the process you can initiate early such as fingerprinting and background checks through your board of nursing to shave off some of this precious time.

    Reply
  20. live casino blackjack

    Can I just say what a comfort to discover a person that really understands what they
    are talking about online. You actually realize how to bring an issue to light
    and make it important. More people ought to read this and understand this side of the
    story. I can’t believe you are not more popular because you most certainly
    possess the gift.

    Reply
  21. Sherry

    I am a private practice NP office , one of our NP’s is retiring . We are hiring a new NP. She has provided her information to get started on credentialing even though her start date is 4 mo away (this is her current contract) , Will this work out or should we wait until the day she begins at our practice. I am worried that it takes so long we will really not be able to set up a schedule for her anytime soon and get paid

    Reply
    • Nadia

      Hi Sherry,

      Thanks for your question! If your new hire has accepted the job offer, I recommend starting on insurance credentialing right away because it can take so long. The risk is investing into credentialing and the candidate potentially withdrawing or not starting as planned, but it’s usually worth the risk to have them able to bill on their start date.

      Nadia
      Team Résumé Rx

      Reply

Submit a Comment

Your email address will not be published. Required fields are marked *