Hub 01 · Credentialing
3 Roles · 6 Positions
Credentialing
The backbone of provider access.
Credentialing professionals verify and maintain the provider documentation that allows clinicians to participate in the VA Community Care Network, state cannabis practitioner programs, and commercial payer networks. In a two-hat practice, that work runs on two parallel tracks at once. A lapse on either side stops payment on both.
CAQH
Council for Affordable Quality Healthcare — ProView / Universal Provider Datasource
NCQA
National Committee for Quality Assurance — healthcare credentialing standards
URAC
Health provider credentialing accreditation body
State Boards
State medical board licensure — multi-state credentialing and PSV
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Credentialing — Subspecialty 01 of 09
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Hub 01 · Overview
What Credentialing Actually Does.
The Two-Hat Reality
In a two-hat practice, credentialing has to hold across both lines of care at once — VA Community Care credentialing under federal authority, and state medical cannabis practitioner credentialing under state authority. A lapse on either side stops payment and access on both. The credentialing professional is the quiet anchor of the entire operation.
The Federal Side
Credentialing for VA Community Care Network participation means verifying and maintaining the provider documentation that allows CCN-eligible claims to be paid through Optum or TriWest. Primary Source Verification, CAQH ProView currency, and ongoing re-credentialing cycles every 36 months keep the federal payer relationship active. VHA Directive 1315 documentation flows back to VA through credentialed community providers — credentialing is what makes that documentation exchange possible.
The State Side
State medical cannabis practitioner credentials are issued by state program offices and operate as a separate credentialing track underneath the federal payer relationship. State medical board licensure, multi-state license maintenance, and state cannabis program registration are distinct credential sets that a State Medical Board Liaison manages in parallel with the federal credentialing workflow. The two tracks do not conflict — but they both require active maintenance to keep the two-hat model legally and operationally sound.
The six positions in this hub cover the full architecture of provider credentialing for two-hat practices — from the Credentialing Specialist’s daily verification workflow through the Coordinator, Analyst, Manager, Recredentialing Specialist, and State Medical Board Liaison. Each role is independent. Each is findable through the Mendry DCSP directory.
The Six Positions
Credentialing Roles in Detail.
Each position covers the daily workflow, required credentials, the two-hat-specific responsibilities, and how the role fits into the independent contractor model. Tap a role to read its full page.
01
Credentialing Specialist
A Credentialing Specialist verifies and maintains the documentation that allows clinicians to participate in VA Community Care Network, TRICARE, CHAMPVA, and commercial payer networks. Every license, every board certification, every malpractice history, every NPI, every CAQH attestation passes through this role. The work is detailed. The work is
The Six Positions
The Bodies and Certifications Behind the Role.
Professional bodies and certifications relevant to this specialty. Mendry is a membership organization — it does not issue these credentials, require them for membership, or verify that any member holds them. They are listed here as a reference for credentialing professionals building their independent practice and for the two-hat practices evaluating candidates.
CAQH — Council for Affordable Quality Healthcare
ProView / Universal Provider Datasource. The primary tool for DCSP credentialing professionals managing provider profiles across multiple payers.
NAMSS — National Association Medical Staff Services
Certifying body for the CPCS (Certified Provider Credentialing Specialist) and CPMSM (Certified Professional in Medical Services Management).
NCQA — National Committee for Quality Assurance
Healthcare credentialing standards. NCQA-based credentialing standards govern the 36-month re-credentialing cycle that most payer networks, including CCN, follow.
URAC
Health provider credentialing accreditation. URAC accreditation requires demonstrated credentialing process standards for organizations managing multiple provider relationships.
State Medical Boards
Multi-state licensure. The State Medical Board Liaison role centers on managing licensure with individual state boards across all states where two-hat providers hold credentials.
FCVS — Federation Credentials Verification Service
Managed by the Federation of State Medical Boards. The FCVS workflow is the standard tool for multi-state licensure management in practices operating across multiple states.
Glossary
Every Acronym Used on This Page.
Defined in full on first use above and collected here as the reference backstop.
CAQH
ProView / Universal Provider Datasource. The primary tool for DCSP credentialing professionals managing provider profiles across multiple payers.
MGMA
Medical Group Management Association — professional association and credentialing track for medical practice managers.
CCN
VA Community Care Network — the U.S. Department of Veterans Affairs network through which community providers deliver care to veterans.
NAMSS
National Association Medical Staff Services — the professional body that issues the CPCS and CPMSM certifications.
CHAMPVA
Civilian Health and Medical Program of the Department of Veterans Affairs — a health benefits program for families of certain veterans.
NCQA
National Committee for Quality Assurance — sets healthcare credentialing standards including the 36-month recredentialing cycle requirement.
CPCS
Certified Provider Credentialing Specialist — a NAMSS certification for credentialing professionals.
PSV
Primary Source Verification — confirming a provider’s credentials directly with the issuing source, as required by NCQA and URAC standards.
CPMSM
Certified Professional in Medical Services Management — a senior-level NAMSS certification.
TRICARE
The U.S. Department of Defense health program for service members, retirees, and their families.
FCVS
Federation Credentials Verification Service — managed by the Federation of State Medical Boards, used for multi-state licensure.
URAC
A healthcare accreditation body with credentialing-specific accreditation standards (program name; no longer spelled out as an acronym).
VA
U.S. Department of Veterans Affairs — the federal department serving veterans.
Find Your Specialty. Find Your People.
Mendry does not employ, place, refer, or supervise Direct Care Support Professionals. We list independent members so the two-hat practices that need them can find them. Your business, your reputation, your decisions.