1. Process of verifying a physician’s medical education, training, and licenses so that a physician can be approved to practice in a hospital. 2. Process delegated by the board to the medical staff of medical staff appointment, reappointment, and delineation of clinical privileges. 3. From a health maintenance organization view, to credential physicians to ensure they have the right training and licensing and maintain information on their specialties.

Health care employee trained to provide medical care under the direct or indirect supervision of a physician (e.g., certified registered nurse practitioner, certified nurse midwife, physician assistant, occupational therapist, clinical psychologist, clinical social worker, clinical nurse specialist, physical therapist, certified registered nurse anesthetist). PEs might also include auxiliary personnel such as registered nurses, licensed practical nurses, technicians, medical assistants, and any other individual acting under a physician’s supervision. Some states specify certain supervision requirements such as physician telephone or on-site access, chart review/sign-off, and conferencing. Further information via the Internet is available at the websites of the American Association of Physician Assistants and the American College of Nurse Practitioners. The Centers for Medicare and Medicaid Services (CMS) refers to PEs as limited license practitioners (LLPs). Also referred to as nonphysician practitioner (NPP), midlevel provider (MLP) , or midlevel practitioner (MLP).

Partnership, association, corporation, individual practice association (IPA), or other group that distributes income from the practice among members. An IPA is considered to be a physician group only if it is composed of individual physicians and has no subcontracts with other physician groups.

Association between one or more hospitals and one or more physicians to assist in negotiation, contract development, administrative services, financial management services, and marketing of managed care plans for its members. The PHO may also undertake utilization review, credentialing, and quality assurance. Physicians have their own practices and continue their traditional business outside the PHO. Also called medical staff-hospital organization.

Any compensation arrangement at any contracting level between a managed care organization (MCO) and a physician or physician group that may directly or indirectly have the effect of reducing or limiting services furnished to Medicare or Medicaid enrollees in the MCO. MCOs must disclose physician incentive plans between groups or intermediate entities (e.g., certain individual practice associations [IPAs], physician-hospital organizations [PHOs]) and individual physicians and groups.

State organization responsible for issuing licenses, accreditation, or certification for a health care provider to practice. Also called Board of Healing Arts, Board of Medical Examiners, Board of Medical Practice, Department of Business and Professional Regulation, and medical licensing board.

Association of physicians who contract with managed care plans as an entity or represent the physician part in a physician hospital organization (PHO). Physician practice financials are linked to assist physicians in managing risk and capitation.