Credentialing Glossary
Board Certification
licensingDefinition
A voluntary credential earned by a physician who has completed residency training and passed a rigorous specialty exam administered by an ABMS member board, demonstrating expertise in a specific medical specialty.
Extended Explanation
Board certification means a physician or other provider has completed additional training and passed a rigorous exam in their specialty beyond what is required for a medical license. It is voluntary but increasingly important for credentialing and payer enrollment.
Not every payer requires board certification, but many do. Some payers will accept board eligibility, which means you have completed the training but have not yet passed the exam. Others have hard requirements that you must be board certified within a certain timeframe after completing residency, typically five to seven years.
Board certification is issued by member boards of the American Board of Medical Specialties (ABMS) for physicians, or equivalent bodies for other specialties. For example, the American Board of Internal Medicine certifies internists, the American Board of Surgery certifies surgeons, and the American Board of Psychiatry and Neurology certifies psychiatrists.
Most board certifications now require Maintenance of Certification (MOC), which means ongoing education and periodic re-examination. If your certification lapses because you did not complete MOC requirements, payers will find out during re-credentialing, and it can affect your network participation.
During credentialing, the payer verifies your board certification directly with the certifying board. They check the date of certification, the specialty, whether it is current, and any subspecialty certifications. This is done as part of primary source verification.
If you are not board certified and a payer requires it, ask about their exceptions process. Some payers will grant network participation to non-board-certified providers in underserved areas or specialties with shortages. But do not assume. Ask the question upfront before investing time in the application.