What are Credentialing Activities Under HIPAA?

Modified on Mon, 11 Dec, 2023 at 4:24 PM

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Certain activities are considered to be "healthcare operations" under HIPAA.

Healthcare operations may include, among other activities, "Reviewing the competence or qualifications of health care professionals, evaluating practitioner and provider performance, health plan performance, conducting training programs in which students, trainees, or practitioners in areas of health care learn under supervision to practice or improve their skills as health care providers, training of non-health care professionals, accreditation, certification, licensing, or credentialing activities."


According to the National Institutes of Health (NIH), credentialing is the process of assessing the academic qualifications and clinical practice history of a healthcare provider. According to the NIH, 
"In general, any licensed, independent healthcare professional who has been permitted by law and regulated by a licensing organization to provide services and care without supervision or direction within the scope of the individual’s license, needs to be credentialed."

Credentialing activities may include (among other activities):

1. Verification of identity.
2. Verification of current licensure, registration, or certification

3. Verification of education and training


Credentialing may be considered to be a business associate function if a business associate creates, receives, maintains, and/or transmits PHI to a covered entity for or on behalf of that covered entity. 

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