Physician credentials in healthcare are reviewed every 24–36 months, with hospitals near 24, health plans at 36, plus annual OPPE tracking.
Looking for the calendar behind credential checks? Here’s the short map. Hospitals and health systems reappoint and re-privilege on a fixed cycle. Health plans recredential on their own clock. In between, teams run ongoing monitoring so files never drift. The exact window depends on who oversees the setting, yet the pattern is steady once you see it.
How Often Are Physician Credentials Reviewed In Healthcare: By Setting
Different accrediting bodies steer different clocks. Use this table as a quick guide before the deeper detail below.
| Setting | Typical Review Cycle | Oversight & Notes |
|---|---|---|
| Hospitals/Health Systems | Every 24–36 months | The Joint Commission allows up to 36 months for reappointment/re-privileging; CMS recommends appraisal at least every 24 months. |
| Health Plans/Delegated Networks | Every 36 months | NCQA and URAC require recredentialing at least every three years for network practitioners. |
| Between Cycles | Ongoing | Annual OPPE review in hospitals; monthly license and exclusion monitoring are rising in payer standards. |
Hospitals And Health Systems
The Joint Commission sets a cap on how long a reappointment term can run. Its standards FAQ states that reappointment and re-privileging are due no later than three years from the prior effective date. Many hospitals still hold a two-year rhythm. That choice lines up with long-standing CMS guidance, which recommends a periodic appraisal at least every 24 months when state law doesn’t set a shorter window. Either path works when bylaws match the plan and minutes show timely board action. For the source text, see the Joint Commission reappointment FAQ.
Alongside the calendar sits performance review. Hospitals track professional practice through OPPE. That review looks at activity, outcomes, and trends for each privileged practitioner. The Joint Commission notes that the timeframe for OPPE review can’t exceed 12 months, so medical staff leaders see current data each year at minimum. FPPE comes into play for new privileges or targeted checks after concerns; it runs for a defined period until evidence shows current skill.
Health Plans And Delegated Networks
For payer networks, the clock is three years. NCQA requires recredentialing at least every 36 months, measured month-to-month across cycles. URAC mirrors that three-year bar. Plans that delegate to groups hold those groups to the same rule and audit proof of primary source checks, sanctions queries, and committee decisions. NCQA also sharpens what happens between cycles. New 2025 updates raise the bar on ongoing monitoring, including tighter primary source windows and steady checks that keep network data fresh. Read NCQA’s overview here: NCQA credentialing standards.
What Gets Reviewed At Each Cycle
Every recredentialing or reappointment pulls the same core file. The order varies by site, yet the pieces rarely change. Here’s what sits in scope and how committees use it.
Identity, Licensure, And Boards
Teams verify identity, active state licenses, and DEA/controlled substance registration where applicable. Board status gets checked when claimed. Expiration dates and name changes get mapped to documents. Many groups now track license renewals monthly so nothing lapses mid-cycle.
Sanctions, Exclusions, And Legal Actions
Files show queries to state boards, the OIG exclusion list, Medicare/Medicaid sanctions, and the NPDB. Any hits feed a committee note with scope, dates, and corrective steps where needed.
Education, Training, And Experience
Primary source checks confirm medical school, residency, fellowship, and any subspecialty training. Work history and gaps get a short narrative. A current CV ties it all together, with dates lined up to match forms.
Competence And Performance Data (OPPE/FPPE)
Hospitals bundle OPPE dashboards that reflect outcomes, volume, and other metrics tied to granted privileges. When a clinician seeks a new privilege or shows a drift, FPPE sets a focused plan with a clear end point and sign-off.
Professional References And Peer Input
Most bylaws call for peer references that can speak to current skill and behavior. Plans often accept recent hospital references if they address competence and scope in plain terms.
Insurance And Claims
Professional liability coverage limits and claims history land in the packet. Committees weigh claim patterns alongside OPPE data to see context, trend, and risk.
Ongoing Monitoring Between Cycles
Credentialing isn’t a one-and-done file build. Between cycles, teams scan for changes that could shift risk or scope. The aim is to catch issues early and keep rosters current and usable.
| Item | Who Checks | Usual Cadence |
|---|---|---|
| License Status & Expiration | Health plans, hospitals | Monthly tracking is common in payer programs; at least annual review in hospitals. |
| Federal/State Exclusions | Health plans | Monthly OIG and Medicare/Medicaid screening helps catch changes fast. |
| OPPE Metrics | Hospitals | Annual review at minimum; many services track quarterly to stay ahead. |
How To Stay On Time And Survey-Ready
Here’s a simple playbook that fits both sides of the fence—hospitals and plans. Pick the parts you need and fit them to local bylaws.
Set Clear Bylaws And Policies
Spell out the reappointment or recredentialing cycle, the cutoff for board approval, what triggers FPPE, and who signs each step. Match the Joint Commission cap or the three-year requirement for plans, and keep the 24-month appraisal recommendation in your notes if you follow a two-year cycle.
Build A Rolling Calendar
Work month-by-month. Pull rosters due in 120 to 180 days. Start primary source checks early so any red flags can get cleared before committee. Keep a buffer for holidays and board dates so approvals land on time.
Monitor Licenses And Exclusions Monthly
Automate feeds where you can. If automation isn’t in place, assign a fixed week each month for checks and log the results. Tight logs save rework during audits and speed any payer reviews.
Use OPPE Data In Real Decisions
Don’t let OPPE sit as a dashboard only. Add a short summary to the file that ties metrics to scope and outcomes. If a measure drops or volume dips, write the plan rather than waiting for the next cycle.
Keep Communication Tight
Tell practitioners what you need early and send a checklist with dates. Short, clear requests speed returns and cut back-and-forth. A single point of contact helps a lot.
Edge Cases And How To Handle Them
New Privileges Mid-Cycle
Granting a new privilege after reappointment triggers FPPE for that privilege. The focused review runs until the practitioner shows current skill for the new task. The core reappointment date stays the same unless bylaws say otherwise.
Leaves, Gaps, Or Low Volume
Long leaves or low volume can make OPPE look thin. Use peer review, case logs from another site, or observed cases to show current skill. Document how many cases, who reviewed them, and the dates so the story is clear.
Telemedicine And Cross-Coverage
Credentialing by proxy follows accreditor rules and contracts. Make sure the distant-site partner meets the same reappointment cycle and monitoring rules you’d apply at home. Keep the contract, the roster, and the due dates in one place.
State Law Sets A Shorter Clock
Some states set shorter terms or add extra checks. In those places, follow the stricter rule. Update bylaws and policy language so surveyors see a clean match and staff see clear steps.
What Surveyors Look For
When surveyors review files, they look for a few simple things done well. Hitting these points keeps findings light and cycles smooth.
- Board approvals before the current term ends, with effective dates lined up.
- Primary source evidence dated within the allowed window for the decision.
- OPPE summaries tied to the exact privileges on the privilege form.
- FPPE plans that name who reviews, what cases, and the stop point.
- Sanctions and exclusion checks logged with dates and sources.
- Clear proof of current coverage limits and any claim summaries.
Key Differences: Recredentialing Vs. Privileging
Credentialing and privileging are linked yet not the same. Credentialing confirms identity, training, licenses, and clean standing. Privileging grants the specific scope a practitioner may perform at a site. Reappointment refreshes both sets: the person’s file and the list of granted activities. Health plans mirror this with a focus on network participation rather than site-specific privileges.
Aligning Hospital And Plan Clocks
Systems that employ physicians often juggle both calendars. A smooth approach is to run the hospital cycle on 24 months and keep plan recredentialing on 36 months, while sharing primary source results to cut duplicate work. When a hospital picks a 36-month term, confirm that committee dates still support payer needs and that monthly monitoring covers licenses and federal exclusions.
OPPE Metrics That Work
Useful OPPE sets favor a small list tied to scope. Pick metrics the service chief can read in minutes and explain in one page. Common picks include case volume by privilege, return to OR, unplanned transfer, readmissions in a set window, turnaround time where it fits, and peer feedback for teamwork and communication. The point is steady trend insight paired with action when a trend bends.
Sample Timeline For A Two-Year Hospital Cycle
This sample keeps tasks in view and avoids last-minute scrambles. Adjust day counts for three-year cycles or plan standards as needed.
180–120 Days Out
Kick off file pulls, send notices, and start license and board checks. Begin NPDB, OIG, and state board queries. Request references if your bylaws require new ones each cycle so letters arrive with time to spare.
90–60 Days Out
Wrap primary source verification. Load OPPE summaries. Resolve any gaps in training or work history. If a new privilege sits in the packet, sketch the FPPE plan and list who will review cases.
45–30 Days Out
Committee review and recommendations. Send board packets with clear effective dates so approvals land before the current term ends. Flag any files with conditions and note the follow-up plan.
Go-Live Date
Update rosters, payer files, and EHR flags. Archive the packet and mark the next due date. Hand off any FPPE tasks to the service chief and set a quick check-in to confirm closure.
What This Means In Practice
Put it all together and the rhythm looks like this. Hospitals often choose a 24-month reappointment window with annual OPPE review. The Joint Commission lets that window stretch to 36 months when bylaws and state law allow. Health plans use a 36-month recredentialing cycle backed by steady monitoring for licenses and federal exclusions. Across the board, clear bylaws, steady monitoring, and timely board action keep credentialing clean, current, and defensible.