How often is credentialing repeated?

Most organizations re-credential providers on a fixed cycle, commonly every three years, to confirm that licenses, certifications, and sanction status remain current.

Is exclusion screening part of credentialing?

Yes. Checking a provider against the OIG LEIE and other exclusion lists is a standard credentialing and re-credentialing step, because an excluded provider cannot be paid by federal health care programs.

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What is provider credentialing?

Full name: Health Care Provider Credentialing

Provider credentialing is the process by which health plans, hospitals, and health systems confirm a clinician's qualifications — license, education, training, board certification, and history — before granting privileges or network participation. Credentialing relies on primary-source data, and re-credentialing repeats it on a set cycle. Exclusion and sanction checks against federal lists are a standard part of the process.

Last updated: 2026-06-20Reviewed by: Dr. Jennifer Montecillo, MD — Gullas College of Medicine, 2019. Non-practicing medical reviewer.

How it’s used

CMS NPPES NPI Registry: credentialing teams confirm a provider's NPI, taxonomy, and practice data against the public NPPES file.
OIG LEIE (oig-leie): exclusion screening against the LEIE is a standard credentialing step, since an excluded provider cannot be paid by federal programs.
CMS PECOS Medicare Provider Enrollment: Medicare participation status from PECOS supports network and privileging decisions.
Fonteum resolves these sources to one provider record with field-level provenance, so a credentialing file traces each fact to a named federal source and date.

Frequently asked questions

What is provider credentialing?: Provider credentialing is the process health plans and hospitals use to confirm a clinician's license, training, board certification, and history before granting privileges or network participation.
How often is credentialing repeated?: Most organizations re-credential providers on a fixed cycle, commonly every three years, to confirm that licenses, certifications, and sanction status remain current.
Is exclusion screening part of credentialing?: Yes. Checking a provider against the OIG LEIE and other exclusion lists is a standard credentialing and re-credentialing step, because an excluded provider cannot be paid by federal health care programs.

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