Privileges

The specific clinical services and procedures a healthcare provider is authorized to perform at a particular healthcare facility, granted based on their training, experience, and competency.

Privileges refer to the specific clinical activities that a provider is authorized to perform at a particular facility, usually a hospital. This is different from credentialing with a payer. Hospital privileges are granted by the hospital's medical staff office and governing board based on your training, experience, and competence in specific procedures. For example, a general surgeon might have privileges to perform appendectomies, cholecystectomies, and hernia repairs at Hospital A, but not cardiac procedures. An obstetrician might have privileges for vaginal deliveries and C-sections but not gynecologic oncology procedures. The specific list of procedures you are authorized to perform is called your privilege delineation. Payer credentialing applications often ask about your hospital privileges. They want to know which hospitals have granted you privileges, what types of procedures you are privileged for, and whether any privileges have ever been denied, restricted, suspended, or voluntarily relinquished. This last part is important because giving up privileges while under investigation is treated similarly to having them revoked. Payers will ask, and the NPDB will report it. If you are an outpatient-only provider and do not have hospital privileges, most payers will accept that. But you may need to demonstrate that you have an arrangement with a hospital for emergency admissions, or that your specialty does not typically require hospital-based practice. Hospital privilege applications are a separate process from payer credentialing and can take just as long. Many hospitals require the same documentation: licenses, certifications, malpractice history, references, and procedure logs. If you are starting at a new hospital, begin the privileging process at the same time you start payer credentialing so the two processes run in parallel.