What is a credentialing committee, and what role does it play?

A credentialing committee is a formal review body that evaluates credentialing information and makes or recommends provider participation decisions according to policy.

The committee typically reviews verified provider information such as licenses, education, professional history, sanctions, malpractice information, and other required disclosures. Credentialing staff prepare complete files for review, while the committee performs the decision-making or recommendation function defined by the organization. Adverse information should be handled transparently and according to policy.

• Credentialing committees review completed provider files.
• They may approve, deny, restrict, or recommend participation decisions.
• Credentialing staff prepare verified information.
• Decision records should be documented.

A provider file contains a disclosed malpractice event. The credentialing specialist verifies the information and presents the complete file for committee review rather than making the decision independently.

• Treating committee review as a formality.
• Omitting adverse information.
• Sending incomplete files for review.

Separate the credentialing specialist’s verification role from the committee’s decision role.