Practitioner credentialing

Credentialing is the important and necessary process of obtaining, verifying, and assessing the qualifications of a health care practitioner to provide patient care services in or for a health care organization.

Your rights

You have the right to review information submitted in support of your credentialing application and to correct erroneous information. You may not review peer reviews, peer references, and other peer-review protected materials.

You also have the right, upon request, to be informed of the status of your credentialing or recredentialing application.

Initial credentialing

You must be credentialed before providing covered services to our members. This includes new practitioners who are joining an already credentialed group practice.

To contract with Kaiser Permanente, you must complete our credentialing process and be approved by our Credentialing Committee. We will notify you in writing when your application is approved. Once the contract is finalized and credentialing approval is complete, you may begin providing covered services to our members.

As part of the review, we conduct periodic medical record audits of all primary care providers. See Medical records reviews.

Recredentialing

You must be recredentialed every three years. Among other things, we assess the following:

  • Outcomes from patient complaints
  • Quality improvement activities
  • Member satisfaction

Other quality measures may be adopted by Kaiser Permanente as well. We may also initiate a facility or medical record audit at any time based on patient complaints or other concerns.


Content on this page is from the provider manual | Disclaimer