AMA Credentialing Products and Services Measured Against Regulatory and Accreditation Standards
Revised August 2023
Symbols/indicators
✓ = meets standards
+ = exceeds standards through higher level of compliance or industry leading practice
(1) NCQA and CMS for Medicare Advantage require primary source verification of license directly with the licensing board and license sanctions directly with the licensing board or other recognized source
AMA PHYSICIAN PROFILE (MD and DO)
Hospital Setting | Managed Care | AAAHC | URAC | |||||||
Credentials Element | Source | CMS | TJC* | ACHC/HFAP† | DNV | CMS | NCQA | |||
Licensure: Current | State licensing board | ✓ | ✓ | ✓ | ✓ | (1) | (1) | ✓ | ✓ | |
Licensure: Historical | State licensing board | + | + | ✓ | + | + | + | + | + | |
US education | AAMC and osteopathic schools | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | |
ACGME-accredited training | ACGME-accredited programs | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | |
ABMS board certification | ABMS | + | + | ✓ | + | ✓ | ✓ | ✓ | ✓ | |
NPI number | CMS NPPES | + | + | + | + | + | + | + | + | |
DEA registration | DEA | + | + | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | |
Sanction alerts‡ | Licensure: Current | State licensing board | + | ✓ | ✓ | ✓ | (1) | (1) | + | ✓ |
Licensure: Historical | State licensing board | + | + | ✓ | + | (1) | (1) | + | ✓ | |
Medicare/Medicaid | OIG | + | + | ✓ | + | ✓ | ✓ | + | ✓ | |
DEA | DEA | + | + | + | + | + | + | + | + | |
US Air Force, Army, Navy, DOD, and VA: Historical | Respective military branch/agency | + | + | + | + | + | + | + | + | |
ECFMG identification number | ECFMG | AMA provides the number only. |
CONTINUOUS MONITORING SERVICE OF PHYSICIAN PROFILES
Hospital Setting | Managed Care | AAAHC | URAC | |||||||
Sections Monitored on an Ongoing Basis | Update Notification Trigger | CMS | TJC* | ACHC/HFAP | DNV | CMS | NCQA | |||
Sanction alerts | Licensure: Current and historical | Alert from state licensing board | + | + | + | + | (1) | (1) | + | ✓ |
Medicare/Medicaid | Alert from OIG | + | + | + | + | ✓ | ✓ | + | ✓ | |
DEA | Alert from DEA | + | + | + | + | + | + | + | + | |
Licensure | Changes in:
| ✓ | ✓ | ✓ | ✓ | + | + | + | + | |
NPI number | Changes in:
| + | + | + | + | + | + | + | + | |
DEA registration | Changes in:
| + | + | ✓ | + | + | + | + | + | |
ABMS board certification | Changes in:
| + | + | + | + | + | + | + | + | |
ACGME-accredited training | Changes in:
| + | + | + | + | + | + | + | + | |
US education | Changes in:
| + | + | + | + | + | + | + | + |
Information current as of Aug. 18, 2023. ©2023 American Medical Association. All rights reserved.
Download an important file containing acceptance of AMA Physician Professional Data™ from TJC, NCQA, and AAAHC as well as an ABMS statement on AMA as an official display agent.
Symbols/indicators
✓ = meets standards
+ = exceeds standards through higher level of compliance or industry leading practice
(1) NCQA and CMS for Medicare Advantage require primary source verification of license directly with the licensing board and license sanctions directly with the licensing board or other recognized source.
Notes
* The Joint Commission accreditation standards deem the AMA Physician Professional Data™, formerly AMA Physician Masterfile, which populates AMA Physician Profiles, as a designated equivalent source for physician medical school, postgraduate medical training, and (due to its official ABMS display agent status) ABMS board certification. All other primary-source-reported information on the AMA Physician Profile meets and exceeds TJC principles for a credentials verification organization. See the AMA response to TJC CVO requirements.
† ACHC/HFAP requires primary source verification of licensure but additionally requires a query of the National Practitioner Data Bank and of the Federation of State Medical Boards or the Fraud and Abuse Control Information System.
‡ Sanction Alerts: AMA provides notification only of sanctions in the profile’s “Action Notifications” section. Contact the primary source directly for sanction details.
Acronyms
AAAHC = Accreditation Association for Ambulatory Health Care, Inc.
AAMC = Association of American Medical Colleges
ABMS = American Board of Medical Specialties
ACHC = Accreditation Commission for Health Care
ACGME = Accreditation Council for Graduate Medical Education
AMA = American Medical Association
CMS for hospital setting = Centers for Medicare & Medicaid Services: Conditions of Participation for Hospitals
CMS for managed care setting = Centers for Medicare and Medicaid Services: Medicare Advantage
DEA = Drug Enforcement Administration
DNV = DNV Healthcare
DOD = Department of Defense
ECFMG = Educational Commission for Foreign Medical Graduates
HFAP = Healthcare Facilities Accreditation Program
NCQA = National Committee for Quality Assurance
NPPES = National Plan and Provider Enumeration System
OIG = Office of Inspector General
TJC = The Joint Commission
VA = Veterans Administration
Disclaimer
This publication is for information purposes only. The AMA has consulted authors and editors believed to be knowledgeable in their fields to produce this publication. However, the AMA encourages readers to consult their own professional advisors or the accrediting bodies. The AMA disclaims all warranties and liability for this content.