💡 Plain English Explanation

Healthcare provider credentialing information includes the professional background, qualifications, and practice data of physicians, nurses, and other healthcare practitioners. This information is shared during employment negotiations, network participation agreements, hospital privileges applications, and practice acquisitions.

While not PHI (it relates to providers, not patients), credentialing information is highly sensitive because it can include disciplinary history, malpractice claims, personal financial information, and competitive intelligence about practice operations. Improper disclosure can damage careers, expose liability, and harm competitive positions.

Types of provider information requiring protection:

⚠ Why This Clause Matters

For Healthcare Organizations: When recruiting physicians, negotiating practice acquisitions, or conducting peer review, you receive highly sensitive information about provider qualifications and performance. Confidentiality protections are essential to maintain trust in these processes and comply with state peer review protection laws.

For Healthcare Providers: Your professional reputation and livelihood depend on proper handling of your credentialing information. Disclosure of malpractice history, disciplinary actions, or negative peer review findings can be career-ending. You need strong contractual protections when sharing this information.

For Legal Protection: Many states have statutes protecting peer review information from discovery in litigation. Improper disclosure of peer review materials may waive these protections. NDA provisions must align with applicable state peer review privilege laws to maintain these protections.

📄 Clause Versions

Balanced Version: Protects provider information while allowing appropriate use for credentialing and evaluation purposes. Suitable for employment negotiations, network participation, and hospital privileging. 
HEALTHCARE PROVIDER INFORMATION

1. Definition of Provider Information.

"Provider Information" means confidential information relating to healthcare providers, including:

(a) Credentialing Information:
    (i) Medical education, training, and board certification records;
    (ii) State medical license information and DEA registration;
    (iii) Hospital privileges and clinical affiliations;
    (iv) Work history and professional references;
    (v) National Practitioner Data Bank (NPDB) query results; and
    (vi) Background check results and verification documents.

(b) Performance Information:
    (i) Peer review materials and quality assessments;
    (ii) Clinical outcomes data and quality metrics;
    (iii) Patient satisfaction scores and complaint history;
    (iv) Malpractice claims and settlements; and
    (v) Disciplinary actions and investigations.

(c) Practice Information:
    (i) Compensation and benefits information;
    (ii) Patient volume and revenue data;
    (iii) Payer contracts and reimbursement rates;
    (iv) Referral relationships and patterns; and
    (v) Practice valuation information.

2. Permitted Uses.

Provider Information may be used only for the following purposes:

(a) Evaluating the provider for employment, privileges, or network participation;
(b) Conducting credentialing and privileging activities required by law or accreditation standards;
(c) Performing peer review activities protected under applicable state law;
(d) Negotiating the terms of an employment agreement or practice acquisition; and
(e) Such other purposes as expressly authorized in writing by the provider.

3. Confidentiality Protections.

(a) The Receiving Party shall maintain Provider Information in strict confidence and shall not disclose such information to any person except:
    (i) Those with a legitimate need to know for the permitted purposes;
    (ii) As required by law, regulation, or legal process;
    (iii) To accreditation organizations conducting surveys; or
    (iv) With the provider's prior written consent.

(b) Peer review materials shall be maintained in accordance with applicable state peer review protection statutes, and the parties shall take no action that would waive peer review privilege.

(c) NPDB reports shall be used only for credentialing purposes and shall not be disclosed except as permitted by 45 C.F.R. Part 60.

4. Data Security.

Provider Information shall be stored in secure systems with access limited to authorized personnel. Electronic transmissions shall be encrypted. Physical documents shall be maintained in secured locations.

5. Retention and Return.

(a) If the provider is not employed, privileged, or enrolled, Provider Information shall be returned or destroyed within thirty (30) days of the decision, except as required for legal compliance or legitimate business records.

(b) The Receiving Party shall maintain credentialing files in accordance with accreditation requirements and applicable law.
Disclosing Party Favor (Healthcare Provider): Maximum protection for provider information with strict use limitations and robust notification requirements. Use when sharing sensitive career information during employment negotiations or privileging. 
HEALTHCARE PROVIDER INFORMATION

1. Comprehensive Definition.

"Provider Information" means all information, data, documents, and materials relating to the healthcare provider ("Provider"), including but not limited to:

(a) All credentialing documentation submitted or obtained in connection with the privileging or employment process;
(b) All verification results, including primary source verifications;
(c) All peer review materials, quality data, and performance evaluations;
(d) All malpractice history, including claims, suits, settlements, and judgments;
(e) All disciplinary actions, investigations, or inquiries by any licensing board, hospital, employer, or professional organization;
(f) All compensation information, including current and proposed compensation, benefits, and incentives;
(g) All practice financial information, including revenue, expenses, patient volumes, and payer mix;
(h) All personal information, including Social Security number, date of birth, and background check results;
(i) All communications between the parties regarding the Provider; and
(j) The fact that discussions are occurring between the parties.

2. Strict Use Limitations.

(a) The Receiving Party shall use Provider Information solely for the purpose of evaluating whether to enter into a specified relationship with the Provider. No other use is permitted.

(b) The Receiving Party shall NOT:
    (i) Share Provider Information with competitors, affiliates, or other entities considering similar relationships;
    (ii) Use Provider Information to recruit other providers or to compete with Provider's current practice;
    (iii) Retain Provider Information if the contemplated relationship does not proceed;
    (iv) Use malpractice or disciplinary information for any purpose other than credentialing evaluation;
    (v) Disclose the existence of discussions to Provider's current employer, partners, or patients; or
    (vi) Make any public statement regarding Provider without prior written consent.

3. Enhanced Confidentiality.

(a) Provider Information shall be treated with the highest degree of confidentiality and shall be disclosed only to individuals directly involved in the evaluation decision who have signed confidentiality agreements.

(b) The Receiving Party shall designate a single point of contact for all matters involving Provider Information.

(c) Provider Information shall never be:
    (i) Discussed in settings where unauthorized persons may overhear;
    (ii) Stored on personal devices or unsecured systems;
    (iii) Transmitted by unencrypted email; or
    (iv) Left unattended in accessible locations.

(d) The Receiving Party shall immediately notify Provider of any suspected unauthorized access or disclosure.

4. Peer Review Protections.

(a) All peer review materials shall be maintained in accordance with the strictest interpretation of applicable state peer review privilege laws.
(b) The Receiving Party shall assert all available privileges and protections if compelled to disclose peer review materials.
(c) No peer review information shall be disclosed to plaintiffs' attorneys, malpractice insurers (other than Provider's own insurer), or the National Practitioner Data Bank except as required by law.

5. Notification and Control.

(a) Before making any adverse decision based on Provider Information, the Receiving Party shall notify Provider and provide an opportunity to review and respond to the information.
(b) Provider shall be notified within 24 hours of any request by a third party for Provider Information.
(c) Provider shall have the right to review and request correction of any Provider Information maintained by the Receiving Party.

6. Return and Certification.

(a) If the contemplated relationship does not proceed, or upon Provider's request at any time, the Receiving Party shall:
    (i) Return all Provider Information within ten (10) days;
    (ii) Permanently delete all electronic copies;
    (iii) Destroy all physical copies; and
    (iv) Provide written certification of return and destruction.

(b) The Receiving Party shall not retain any copies, notes, or summaries of Provider Information.

7. Remedies.

Provider shall be entitled to injunctive relief and actual damages for any breach of this section. The Receiving Party shall indemnify Provider for any harm to Provider's reputation, career, or earning capacity resulting from unauthorized disclosure.
Receiving Party Favor (Healthcare Organization): Reasonable protections while preserving operational flexibility for credentialing, peer review, and employment processes. Appropriate for hospitals, health systems, and payers conducting routine credentialing. 
HEALTHCARE PROVIDER INFORMATION

1. Definition of Provider Information.

"Provider Information" means information submitted by or on behalf of the Provider in connection with a credentialing, privileging, employment, or network participation application, specifically including:

(a) Application forms and supporting documentation;
(b) Verification results obtained through the credentialing process;
(c) References and recommendation letters;
(d) License and certification information; and
(e) Information expressly designated as confidential by the Provider.

Provider Information does not include:
(i) Information that is publicly available or becomes publicly available;
(ii) Information obtained from sources other than the Provider;
(iii) The Organization's internal evaluations, assessments, and decisions; or
(iv) Aggregate or de-identified data that does not identify the Provider.

2. Permitted Uses and Disclosures.

The Organization may use and disclose Provider Information for:

(a) Credentialing, privileging, and recredentialing activities;
(b) Peer review and quality improvement activities;
(c) Employment and compensation decisions;
(d) Network management and provider directory purposes;
(e) Compliance with legal and regulatory requirements;
(f) Accreditation surveys and audits;
(g) Responding to inquiries from other healthcare organizations conducting credentialing (with reasonable verification of legitimacy);
(h) Defense of legal claims involving the Provider; and
(i) Such other purposes consistent with standard healthcare industry practices.

3. Reasonable Confidentiality.

(a) The Organization shall maintain Provider Information with reasonable care and shall limit access to those with a legitimate business need.

(b) The Organization may disclose Provider Information:
    (i) To its credentialing committee, medical staff leadership, and governing body;
    (ii) To its legal counsel and professional advisors;
    (iii) To accreditation and regulatory bodies;
    (iv) To other healthcare organizations for credentialing purposes;
    (v) As required by law or legal process; and
    (vi) To malpractice insurers and risk management.

(c) The Organization shall maintain peer review materials in accordance with its standard policies and applicable law.

4. Data Retention.

(a) The Organization may retain Provider Information in accordance with its standard records retention policies and applicable legal requirements.

(b) Upon termination of the Provider's relationship with the Organization, the Organization may retain Provider Information:
    (i) As required by law and accreditation standards;
    (ii) For defense of potential legal claims;
    (iii) For response to future credentialing inquiries from other organizations; and
    (iv) In archived or backup systems not readily accessible.

5. Provider Representations.

The Provider represents that all information provided is true, complete, and accurate. The Provider authorizes the Organization to verify information and to obtain additional information from third parties. The Provider releases the Organization from liability for good faith use of Provider Information in credentialing and employment decisions.

6. Limitation of Liability.

The Organization shall not be liable for:
(a) Disclosures required by law or made in good faith to authorized recipients;
(b) Disclosures made with the Provider's consent;
(c) Actions taken in reliance on incomplete or inaccurate information provided by the Provider; or
(d) Employment or privileging decisions based on Provider Information.

The Organization's liability under this section shall not exceed direct damages and shall be limited to the Organization's negligent or wrongful acts.

💬 Key Considerations