Your Providers Can Practice in 43 States. Can Your Credentialing Process Keep Up?

More states, more credentials to track

A travel nurse holds a compact license covering four states. She picks up assignments in Pennsylvania, Connecticut, and Georgia over six months. Her licensure is straightforward: one multistate license, issued from her home state, recognized across all three.

Her credentialing file, however, is anything but straightforward. Each facility where she works still requires primary source verification of her education and training. Each one runs its own OIG and SAM screening, checks references, verifies employment history, and completes privileging independently. The compact license gets her through the door. It does not get her through the credentialing process.

The Nurse Licensure Compact now covers 43 jurisdictions, confirmed by the National Council of State Boards of Nursing. Pennsylvania joined in July 2025. Connecticut followed in October 2025. Legislation is pending in Alaska, Hawaii, Illinois, Michigan, Minnesota, New York, Oregon, and Washington DC. On the physician side, the Interstate Medical Licensure Compact covers 44 jurisdictions, with North Carolina processing IMLC applications since January 2026 (IMLCC) and New Mexico's governor signaling intent to sign as of February 2026 (New Mexico Governor's Office).

Compacts are growing fast. The common assumption is that growth makes credentialing easier. It does not.

Compacts solve a licensure problem, not a credentialing problem

Licensure and credentialing answer different questions. Licensure asks whether a provider is legally permitted to practice in a state. Credentialing asks whether a provider meets the standards of the specific organization where they will deliver care. A compact license satisfies the first question across multiple states simultaneously. It does not touch the second.

Each state board still operates on its own renewal cycle. Continuing medical education requirements vary by state. Disciplinary reporting timelines differ. Verification response speeds range from instant electronic checks to weeks-long manual processes. A provider credentialed at a health system in Texas and picking up shifts at a facility in Virginia through the same compact license still needs a full, independent credentialing file at the Virginia facility.

The Joint Commission and NCQA do not grant exceptions for compact-licensed providers. Initial credentialing, recredentialing, ongoing monitoring, and privileging requirements apply regardless of how the provider obtained their license.

Compact growth is accelerating provider mobility

Compact expansion removes the friction that kept providers geographically anchored. That is its intended purpose, and it is working. According to CHG Healthcare's 2025 State of Locum Tenens Report, 56,000 physicians now work locum tenens assignments across the country. Sixty-three percent of US physicians report working locum tenens or considering it within the next five years. The locum tenens market is projected to reach $9.9 billion in 2026, and 80% of facilities expect to maintain or increase their use of locum providers.

For staffing firms and health systems managing these providers, every new compact state increases the volume of active credentialing files. A nurse who previously worked in two states now works in five. A physician using the IMLC picks up assignments across state lines with minimal licensure delay. The credentialing team manages the additional files, renewal dates, and monitoring obligations that come with each new practice location.

A staffing firm that placed nurses in 8 states two years ago may now place them in 15. The credentialing files multiply accordingly, each with its own renewal dates tied to different state board cycles. Verification requests go out to boards that respond at different speeds, and the compliance team managing all of it has not grown proportionally.

Michigan is withdrawing from the IMLC

Not every state is moving in the same direction. Michigan withdrew from the Interstate Medical Licensure Compact effective March 28, 2026 (IMLCC). For organizations credentialing physicians who held Michigan IMLC licenses, the practical effect is immediate.

Physicians who obtained Michigan licensure through the compact need to confirm their license status directly with the Michigan Board of Medicine. Organizations with Michigan-based providers in their pipeline should verify whether those licenses remain active under state-specific rules rather than compact provisions. Ongoing monitoring that relied on IMLC data feeds for Michigan licensure status will need a new verification pathway, which means credentialing teams need to identify affected providers and update their tracking processes before the effective date.

Michigan's withdrawal is a reminder that compact membership is not permanent. States can join and leave. A credentialing process built around the assumption that a provider's compact status is static will miss these shifts.

State-by-state variation does not disappear with a compact license

A compact license standardizes the licensure mechanism. It does not standardize the regulatory environment behind it. Two examples illustrate the point.

CME requirements for nurses vary between compact member states. Some states require specific coursework in topics like opioid prescribing or cultural competency. Others accept a flat hour count without topic restrictions. A nurse holding a compact license and working in multiple states may need to satisfy different CME profiles depending on where they practice, even though a single license covers all those states.

Disciplinary action reporting also varies. If a state board takes action against a provider in one compact state, the timeline and mechanism for that information reaching other compact states depends on the reporting infrastructure each board maintains. Nursys, the national nurse license verification system, provides a centralized lookup, but the speed at which individual boards update records varies.

For credentialing teams, these variations mean that a single provider working under a single compact license can generate multiple, distinct compliance tracking obligations depending on their practice locations.

What this means for credentialing operations

Staffing firms feel this pressure most directly. A firm placing 200 travel nurses across 15 compact states is managing 200 individual credentialing files, each mapped to facility-specific requirements, each tracked against state-specific renewal dates and CME cycles, each subject to ongoing OIG/SAM screening and primary source verification.

Manual processes break under this load. Spreadsheets cannot reliably track expiry dates across multiple state boards with different renewal windows. Email-based document collection creates bottlenecks when a provider is moving between assignments every 13 weeks. Paper files make audit readiness impossible when a Joint Commission surveyor asks for documentation on a provider who worked at three facilities in the last year.

The operational question is not whether compacts are good for the healthcare workforce. They are. The question is whether credentialing infrastructure can absorb the volume and complexity that compact expansion creates.

Credentially tracks credentials across state lines in a single system

Credentially was built for healthcare credentialing and compliance, and has been in continuous development since 2017. The platform manages the full credentialing lifecycle, from initial application through ongoing monitoring, within a single system designed for multi-state provider populations.

For organizations managing compact-licensed providers, this means license expiry dates tracked by state and renewal cycle, not in a single flat list. Primary source verification requests are initiated automatically and tracked through completion. OIG and SAM screening runs on a scheduled cycle across the full provider roster. Document collection happens through a guided digital workflow where providers submit credentials once and those credentials follow them across assignments.

When a state like Michigan changes its compact status, the credentialing team sees the effect on affected providers immediately rather than discovering it during an audit.

The platform handles the complexity that compacts create by keeping credential tracking granular at the state level while managing the full lifecycle in one place.

Does a compact license eliminate the need for credentialing at each facility?

No. Compact licenses cover licensure only. Each facility where a provider delivers care must complete its own credentialing process, including primary source verification, reference checks, OIG/SAM screening, and privileging.

How many states are in the Nurse Licensure Compact as of 2026?

The NLC covers 43 jurisdictions as of early 2026, confirmed by nursecompact.com. Legislation is pending in eight additional jurisdictions.

What happened with Michigan and the IMLC?

Michigan withdrew from the Interstate Medical Licensure Compact effective March 28, 2026. Physicians who obtained Michigan licensure through the IMLC should confirm their license status directly with the Michigan Board of Medicine.

How does compact expansion affect staffing firms specifically?

Compact expansion increases provider mobility, which increases the number of active credentialing files a staffing firm manages at any given time. Each placement still requires full credentialing at the receiving facility, regardless of compact license status.