Are credentialing, privileging and payer enrollment separate?
Yes. Credentialing evaluates qualifications, privileging authorizes specific patient care services and payer enrollment applies for inclusion on insurance panels.
Credentialing ICU physicians, NPs and PAs
ICU coverage planning should review a clinician’s verified qualifications separately from the privileges requested at the facility. This qualitative checklist addresses physicians, NPs and PAs, with state-license planning and facility-specific scope checks.
Sourced facts: separate review steps
The AMA distinguishes credentialing, privileging and payer enrollment. Credentialing evaluates qualifications; privileging authorizes specific patient care services; payer enrollment applies for inclusion on insurance panels. Completing one step does not make the steps interchangeable.
Read the AMA credentialing, privileging and enrollment presentationICU credentialing and privileging checklist
Planning checklist only. Confirm the records and requested privileges with the facility.
Facility-specific procedure privileges
As a general practice, procedure privileges for central lines, intubation and ventilator management are facility-specific. Review the requested privileges against the clinician’s credentials and the facility’s requirements; do not treat this checklist as authorization to perform a procedure.
State-license and scope planning
Plan for the licenses needed for the intended coverage location. NPs and PAs practice under state law and facility bylaws; check the relevant state board.
Saile for facility coverage
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Frequently asked questions
Are ICU procedure privileges the same at every facility?
No. As a general practice, privileges for central lines, intubation and ventilator management are facility-specific. Compare the privileges requested with the credentials held and the facility’s requirements.
What should NPs and PAs confirm for ICU coverage?
NPs and PAs practice under state law and facility bylaws. Check the relevant state board and the facility’s requested privileges.
Does a physician Compact pathway cover NPs and PAs?
No. The physician Compact guide concerns physicians. NPs and PAs should check their relevant state board for licensing requirements.
Sources
General information, not legal, tax or insurance advice. Confirm details with the source and with your state board, employer or insurer.