Healthcare License Verification Checklist: What Every Employer Should Confirm

Credentialing a new provider involves more than confirming their license exists. A license can be active but under probation. A provider can hold a valid state license and still be excluded from federal billing programs. An ACLS certification can be current on paper but issued by a provider not recognized by the Joint Commission.

This checklist covers every verification point a healthcare employer should complete — at hire and on an ongoing basis. For each item, the consequence of missing it is noted, because that's what makes it concrete.

The 10-point verification checklist

1. State license — active and in good standing

Confirm the provider holds an active license in every state where they will practice. "Active" is not the same as "in good standing." A license can be technically active while under probation, subject to practice restrictions, or pending a disciplinary proceeding. Check the issuing state board directly — not just the provider's attestation. This is the foundation of primary source verification.

2. No board actions on record

A board action — reprimand, probation, suspension, consent order, or revocation — may or may not be reflected in the license status field on a state board lookup. Some boards display active board actions clearly; others require a separate search. Check both the license status and the disciplinary history tab. For a full explanation of what these actions mean and how they affect employment eligibility, see what is a board action.

3. OIG LEIE — not excluded

Search the OIG List of Excluded Individuals and Entities by both NPI and name. Name-only searches can miss matches due to name changes or data entry variations; NPI cross-reference reduces false negatives. Employing an OIG-excluded provider and billing federal programs creates liability of $10,000 per item billed plus full repayment. See the detailed breakdown in what the OIG exclusion list is.

4. SAM.gov — not excluded

SAM.gov covers federal exclusions beyond healthcare, and some providers appear there without appearing on the OIG LEIE. The two databases are not duplicates. Both must be checked independently. For the full comparison of how OIG, SAM.gov, and the NPDB differ, see OIG vs SAM.gov vs NPDB explained.

5. State Medicaid exclusion list — not excluded

Every state Medicaid program maintains a separate exclusion list. A provider excluded at the state level may not appear on the federal OIG LEIE. If your organization bills state Medicaid, check the applicable state list for every provider in a billing-relevant role.

6. NPI registered and active

Confirm the provider's National Provider Identifier is registered in the NPPES database and that the taxonomy code matches their actual practice role. An inactive or misclassified NPI creates claims-processing problems and can flag a payer audit.

7. BLS, ACLS, PALS current — role-dependent

Basic Life Support is required for virtually all clinical roles. ACLS is typically required for ICU, ED, anesthesia, and cardiac care settings. PALS is required for pediatric care roles. Verify that certifications are current, issued by a recognized provider (AHA or equivalent accepted by your accrediting body), and that the issue date and expiry align with the provider's claimed completion. Role-specific breakdowns: who needs ACLS and PALS requirements in pediatric care. One credential that frequently falls through the cracks is NRP — required for L&D and NICU staff but often tracked separately from the BLS/ACLS/PALS stack. See our article on NRP requirements for labor and delivery.

8. DEA registration — prescribers only

For any provider with prescribing authority, confirm DEA registration is active, covers the correct schedules, and is registered in the state(s) where the provider will prescribe. A DEA registration does not automatically transfer between states. An expired or inactive DEA number invalidates controlled substance prescriptions and exposes the organization to DEA enforcement.

9. Malpractice insurance — active and adequate

Confirm the provider holds current malpractice coverage with limits that meet your organization's requirements and any credentialing body standards. Verify the certificate of insurance directly with the insurer — not only from the provider. Coverage gaps create uninsured liability exposure and may affect hospital privileges. See how lapsed licenses interact with malpractice coverage.

10. Medicare opt-out status

If your organization participates in Medicare, confirm the provider has not opted out. An opted-out provider cannot have Medicare claims submitted on their behalf — doing so results in claims denial and potential fraud liability. This is distinct from exclusion; opted-out providers have voluntarily elected private contracting and are not in violation of any law. For the full explanation, see what Medicare opt-out means.

At hire vs. ongoing — the critical distinction

Every item on this checklist applies at the time of hire. Most of them also apply on an ongoing basis. A license that is active today can be suspended next month. A provider can be added to the OIG LEIE after onboarding. An ACLS certification that is current at hire will expire within two years.

Point-in-time verification at hire satisfies initial credentialing requirements but does not satisfy the ongoing monitoring obligations that federal program participation, accreditation standards, and malpractice insurers impose. The case for continuous license monitoring is that the gap between periodic manual checks is exactly where compliance failures accumulate.

A compliance program that only checks credentials at hire is a credentialing program. A compliance program that monitors them continuously is a risk management program.

For organizations that want a single platform to automate all ten of these checks — including monthly exclusion screening, expiry alerts, and board action monitoring — see how license compliance automation works in practice.