Abbreviation for community rating by class. See adjusted community rating (ACR).

University degree, postgraduate training and education, licensure and/or board certification that indicates a person or institution has obtained professional status in a specific field of health care.

Association that validates a health care professional’s background, licensing, and schooling, and follows continuing education and other measures of professional performance.

1. Generic term that refers to either licensing or certification. 2. Act of reviewing and evaluating qualifications such as education, training, experience, medical degrees, licensure, other credentials, malpractice, and any disciplinary record of a medical provider for quality assurance for the purpose of granting hospital staff membership to give patient care services. Periodically, a check of the status of staff qualifications is done and is referred to as recredentialing . 3. Process by which a managed care plan endorses that a physician is competent to render medical services to members of the plan. Also see economic credentialing.

Amount of credit given to a group’s actual insurance claims experience in establishing a projection of future claims or in calculating a dividend. Also called credibility factor.

1. From the Latin credere, meaning “to believe” or “to trust”; trust in regard to financial obligation. 2. Accounting; entry reflecting payment by a debtor (patient) of a sum received on his or her account.

1. Any previous health insurance coverage that can be used to shorten the preexisting condition waiting period. See also preexisting condition. 2. Under a Medicare Part D plan, a prescription drug coverage from another private insurance plan (Medigap and employer plans) that meets certain Medicare standards. When a patient is enrolled in a drug plan that gives prescription drug coverage, the plan tells the patient that coverage is equal to or better than the standard model and it is considered creditable coverage. Also called creditable prescription drug coverage.