What is Board Certification?

Board Certification Definition

Board Certification is a key quality indicator used by Payer and Health System Executives to signal excellence to members and stakeholders. During the credentialing process, verification of board certification (through boards like ABMS or AOA) is a mandatory step for most health plans. For Payer Ops, tracking certification expiration dates is a critical compliance task; if a provider’s certification lapses, they may no longer meet the plan's quality standards for participation. Including this information in the Provider Directory helps members make higher-quality care choices.

FAQs

Is board certification the same as medical licensure?

No, licensure is a legal requirement to practice medicine, while board certification is an additional, voluntary credential indicating a higher level of specialization.

How often is board certification verified?

It is typically verified at initial credentialing and then re-verified every two to three years during the re-credentialing cycle.

Can a provider practice without being board-certified?

Yes, unless the specific health plan or hospital bylaws require board certification as a condition of participation.