Lost in Medical Credentialing Acronyms? Here’s Your Go-To Guide

Lost in Medical Credentialing Acronyms? Here’s Your Go-To Guide

If there’s one constant in healthcare, it’s that you can count on encountering an overwhelming number of acronyms—and provider credentialing is no exception. Whether you’re a credentialer or practice manager new to the field or just need a refresher, it can be hard to know which ones actually matter.

We’ve taken the liberty of pulling together a list of the most essential medical acronyms in healthcare to keep on your radar, organized by key areas in provider credentialing. Be sure to bookmark this page for quick reference!

Let’s dive in.

Key Organizations and Regulatory Bodies

In any industry, there are organizations and regulatory bodies you need to be aware of to stay compliant. In provider credentialing, here are the folks you should be aware of:

  • AMA – American Medical Association: As the only medical association that convenes 190+ state and specialty medical societies and other critical stakeholders, the AMA represents physicians with a unified voice to all key players in health care. The AMA maintains the Physician Masterfile, a database containing comprehensive physician information used in credentialing.
  • CMS – Centers for Medicare & Medicaid Services: CMS is the federal agency that provides health coverage to more than 160 million through Medicare, Medicaid, the Children’s Health Insurance Program, and the Health Insurance Marketplace. CMS sets enrollment standards for these programs as well as for providers participating in these programs.
  • DEA – Drug Enforcement Administration: The DEA issues a “DEA number”, a unique identifier assigned to healthcare providers who prescribe, administer, or dispense controlled substances. This number is required by federal law and helps track the distribution of controlled drugs to prevent misuse and ensure public safety.
  • FSMB – Federation of State Medical Boards: Provides comprehensive resources, data access, and legislative advocacy to advance and promote the work of state medical boards.
  • NPDB – National Practitioner Data Bank: A web-based database of reports tracking malpractice, sanctions, and disciplinary actions related to health care practitioners, providers, and suppliers. NCQA – National Committee for Quality Assurance: Uses measurement, transparency, and accountability to accredit health plans and credentialing programs.
  • URAC – Utilization Review Accreditation Commission: Accredits credentialing and healthcare operations through leadership,measurement, and innovation.
  • JCAHO / TJC – The Joint Commission: An independent nonprofit that accredits and certifies health care organizations including hospitals and healthcare organizations that provide ambulatory and office-based surgery, behavioral health, home health care, and nursing care center services; reviews credentialing practices.
  • HHS – US Department of Health and Human Services: Governs healthcare policy; Manages national health programs like Medicare and Medicaid, oversees public health policy, and funds medical research.
  • OIG – Office of Inspector General: Fights waste, fraud, and abuse and to improve the efficiency of Medicare, Medicaid and other HHS programs.
  • SAM – System for Award Management: Maintains a list of excluded individuals/entities from covered transactions

Credentialing Tools, Systems & Platforms

Here, moving on to a comprehensive overview of technologies and solutions designed to streamline, automate, and manage healthcare provider credentialing processes:

Credentialing & Enrollment Processes

Next up, we share acronyms for common provider credentialing and enrollment processes that a credentialist or practice manager should be familiar with:

  • PSV – Primary Source Verification: Verifying credentials directly with the original source
  • CVO – Credentials Verification Organization: A third-party performing primary source verification
  • PCA – Provider Credentialing Application: Common form used for provider credentialing
  • EFT – Electronic Funds Transfer: Used for payments during payor enrollment
  • TIN – Tax Identification Number: Needed for group or individual provider setup
  • SSN – Social Security Number: Used for identity and background verification
  • LOA – Letter of Agreement: Used in payer contracting or temporary credentialing
  • UPIN – Unique Physician Identification Number: Former Medicare provider identifier, replaced by the NPI

Education

The following acronyms represent key checkpoints in verifying a provider’s qualifications, meaning the provider is fully vetted and ready to deliver quality patient care:

  • ECFMG – Educational Commission for Foreign Medical Graduates:  Agency overseeing graduates of foreign medical schools seeking to practice in the US
  • USMLE – United States Medical Licensing Examination: Exam required for licensure to practice medicine in the US

Licenses, Credentials & Certifications

These acronyms are important to know as they determine who can deliver care, prescribe medications, and meet compliance requirements, and missing one can cause delays or regulatory issues:

  • MD – Doctor of Medicine: Traditional medical degree
  • DO – Doctor of Osteopathy: Medical degree with a holistic approach
  • APP – Advanced Practice Provider: Not a physician but performs medical activities typically performed by a physician. Most commonly a nurse practitioner or physician assistant
  • PA – Physician Assistant: Licensed mid-level provider
  • NP – Nurse Practitioner: An advanced practice registered nurse (APRN) with specialized training and education that allows them to diagnose, treat, and manage a wide range of health conditions, much like a doctor.
  • APRN – Advanced Practice Registered Nurse: A broader term for all registered nurses with advanced education and training
  • RN – Registered Nurse: A healthcare professional who provides direct patient care
  • DEA Number: USDOJ-issued license, required to prescribe controlled substances on a federal level
  • CS – Controlled Substance: State license required to prescribe controlled substances, only in certain states
  • CLIA – Clinical Laboratory Improvement Amendments: Certifies labs and practices for certain tests
  • CPR / BLS / ACLS – Cardiopulmonary / Basic / Advanced Life Support: Required certifications for many providers

Credentialing Associations

Just like in any professional field, staying connected to key associations can help medical credentialers and practice managers deepen their expertise and stay current with industry changes. The following organizations offer valuable resources, including annual conferences, training programs, and networking opportunities that support ongoing learning and professional growth:

  • NAMSS – National Association of Medical Staff Services: Organization focused on professionals in the medical staffing and credentialing fields.
  • MGMA – Medical Group Management Association: Premier association for professionals who lead medical practices.

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