Third-Party Credentialing

The American Academy of Family Physicians (AAFP) supports a single, nationally standardized health care professional credentialing application as one way to support administrative simplification.

The AAFP believes that payers:

• who require board certification as a requirement should permit physician participation for residents who have evidence of completing the required training and are actively pursuing meeting the requirements for board certification;
• should not use hospital privileges as an absolute requirement for decisions involving insurance participation nor use lack of specific hospital privileges as cause to deny credentialing;
• should make final physician credentialing determinations within 45 calendar days of receipt of a completed application;
• should grant provisional credentialing, pending a final credentialing determination, if the credentialing process exceeds 45 calendar days;
• should provide an electronic means for the physician to track the application;
• should retroactively compensate physicians for services rendered from the receipt date of physicians’ completed credentialing application upon final, successful credentialing determination; and
• should provide an electronic copy of the fee schedule to the physician upon being successfully credentialed.

(2007) (October 2023 COD)