Credentialing Verification Letter

An official letter from a credentialing body, payer, or licensing board confirming a provider's current credentialing status, enrollment, or licensure.

A credentialing verification letter is the official confirmation document you receive after your credentials have been verified and your enrollment is approved. Different organizations issue different types of verification letters for different purposes. Payer enrollment approval letters confirm that your credentialing has been approved, your effective date, your provider number with that payer, and which products or networks you are enrolled in. Save every one of these. You will need them when setting up billing, when patients ask whether you accept their insurance, and during future credentialing applications that ask about your enrollment history. State licensing board verification letters confirm your license number, type, issue date, expiration date, and current status. Most state boards offer both standard verification letters and primary source verification letters. The primary source version is specifically formatted for credentialing purposes and goes directly from the board to the requesting party. Board certification verification letters come from your specialty board and confirm your certification status, the date of certification, and any subspecialty certifications. ABMS provides an online verification portal that payers and hospitals use for real-time verification. Hospital privilege verification letters confirm your current privileges at a specific facility, the date privileges were granted, whether they are provisional or full, and what specific procedures you are privileged to perform. Maintain a folder of all verification letters you receive. When a new payer or hospital asks for proof of your existing enrollments or privileges, you can provide these letters immediately instead of requesting new ones, which takes time. Some credentialing applications accept copies of verification letters from other organizations as supporting documentation. For example, if Hospital A already verified your board certification, Hospital B might accept a copy of Hospital A's privilege letter as supplemental evidence, though they will still do their own primary source verification.