Unit 4: Administrative Operations
Administrative Operations

Section 2. Human Resources

Credentialing and Privileging Details

Credentialing may be done by a central organization that includes multiple facilities or it may be done at each individual facility, depending on the organization’s policy and structure. A specific individual at the facility should be trained to do all of the credentialing for the facility, if it is to be done locally, to ensure that it is done consistently and thoroughly.

Most, if not all, accrediting organizations require that the credentialing process include primary source verification of the professional diploma, specialty certificate(s), and state license(s). Primary source verification means that direct contact is made with the professional school, residency program, and state licensing board, preferably in writing, to verify the credentials. If the primary source verification is done by phone, then detailed notes of the phone call must be kept, including the date of the contact and the names and titles of the person making the call and the person providing the information. Direct contact by phone or letter should also be made with all professional references as a means to determine current levels of competence.

Privileging is frequently done by developing a list of all of the services (dental services in this case) that the board of directors and/or CEO feel are appropriate to be provided at the clinic. The dentist then checks the services on the list he for which he or she wishes to have full privileges (i.e., with no restrictions), limited privileges (i.e., with some restrictions, such as under the observation of a more senior staff member), or no privileges to provide each service. The chief dentist, if there is one, or the CEO and board then compares the requested privileges with the dentist’s credentials to make sure that there is evidence of adequate training and experience for each of the requested privileges before granting or denying them.

Additional Considerations

A dentist should not attempt to provide services without being both credentialed and privileged at the facility where services are to be provided. Likewise, an organization (facility) should not allow dentists to deliver services unless they are credentialed by the organization and privileged at the facility at which they are practicing. Being credentialed by an organization and privileged at one of its facilities does not imply privileging at any other of the organization’s facilities, unless privileges are specified.

Credentialing and privileging are individual processes unique to each dentist provider. While training, degrees, and licensure (credentialing) may imply the ability to provide certain services, these services should not be provided without specific privileging. Providers Dentists should not assume that their training and experience grants them a right to provide services for which they are not privileged. A few states allow independent practice by dental hygienists (i.e., without the direct supervision of a dentist). If your clinic is within one of these states (check with the state dental practice act, a dental hygienist, as well a dentist, can be assigned independent privileges.

Credentialing generally is a condition of employment and/or membership on the medical staff of a facility. Privileges must be formally requested and granted in writing from the governing body. Credentialing should be reviewed at a frequency defined by the organization’s policies and by-laws, usually every 2 years. Privileging should be reviewed at least as frequently as credentialing. Privileging may change at any time, based on the oral health professional’s additional training, changes in the facility’s ability to provide or support service, or by actions of the privileging body.

Renewal should be based on peer review and ongoing QA programs, with a renewal period not exceeding 2 years. If an oral health professional wishes to add to his or her list of privileges (e.g., as a result of receiving new training or of changes in the scope of services that the facility provides), a formal application for a change in privileges must be made to the privileging body, and new privileges must be granted. Privileges for specific services may also be withdrawn at the request of either the oral health professional or the privileging body. Withdrawal of privileges by the privileging body may be based on either changes in the scope of services the facility provides and supports or as an adverse action from the QA process and peer review. Reduction of privileges based on the latter must be reported to the National Practitioner Data Bank. Such reductions should not be taken lightly and must be well documented. The privileging body must defined appeals procedures in its by-laws or policies and procedures. Failure to specify and uphold the rights of the oral health professional in an adverse action and its appeal process has led to lawsuits and findings against health care organizations.

Whoever is given the responsibility to perform the credentialing and privileging activities should keep either a written or electronic master file that lists all of the credentialed employees and the dates of their significant credentials, such as:

  • Date of appointment to the staff and date for renewal
  • Date for renewal of license(s)
  • Date for renewal of malpractice insurance
  • Date for renewal of specialty certification
  • Date for renewal of cardiopulmonary resuscitation (CPR) and advanced cardiovascular life support certifications and others

The credentials coordinator should check this file monthly and ensure that all credentials are kept up to date. Notices for renewal of credentials should be sent out to employees at least 2 months in advance of the expiration of the credentials to allow time to gather and submit necessary documentation.