Medical Credentialing Checklist | Healthcare Credentialing Documents Checklist
Credentialing is crucial for you as a healthcare provider, especially if you want to enjoy the privilege of administering care to your patients. You must be credentialed before you can practice and re-credentialed after every 2-3 years.
The credentialing process is not easy, and it can be time-consuming. Credentialing typically takes 3-4 months, but one minor error could see that period extended. Even if you have a basic knowledge of the requirements and process, you are not infallible.
That’s why we have created the following medical credentialing checklist to help you in the credentialing process.
The Credentialing Checklist
National provider identification (NPI)
The National Provider Identification Number (NPI) is a unique identifier used by the United States National Plan and Provider Enumeration System to identify healthcare providers registered to do business in the United States. This number is unique for both solo and group practitioners.
Practitioner License(s)
This is an essential part of the credentialing checklist because it will show you have a government-issued license to practice medicine. Typically most practitioner licenses are renewed yearly. A listing of past or expired licenses may be likewise requested,
Malpractice Insurance (Certificate of Insurance)
Your new practice will usually ask you about your malpractice coverage, especially if you don't have it already. Insurers review multiple years of claims frequency and severity when evaluating a case.
Medical professional liability insurance is also known as error and omissions coverage (E&O). Healthcare professionals are protected by medical malpractice insurance against claims alleging negligence caused patients' injuries.
During credentialing, you will be asked for information such as certificate number, maximum individual and aggregate limits, occurrence versus claims-made policy, part- versus full-time status, practice location, coverage dates, and any retroactive date of application.
Board Certification(s)
Board certification(s) is a requisite during every credentialing process. The respective professional boards confer them for a defined scope of practice. It portrays the level of expertise and expertise that a physician has in the subject matter domain.
It is usually a prerequisite for acceptance into residency positions or evaluation for fellowship training. Most board certifications last between 6 to 10 years. For example, Pediatrician requires boards that specialize in pediatric medicine.
DEA (federal) certificate and CDS (state)certificate
It is usually requested during the credentialing process. This is issued by the Drug Enforcement Agency (DEA). Having a DEA registration number means you are authorized to prescribe controlled substances in the United States.
Updated Curriculum Vitae
The credentialing checklist should be your updated CV, which shows your specialty, training, work experience, publications, and all other relevant information to healthcare companies. Ensure every detail is stated correctly. Include a list of references to which can be contacted for further details.
Copy of highest level of education/ Diploma (required for non-MD’s, DO’s)
The credentialing checklist should also include your highest level of education, which will show that you are qualified to practice. Ensure that you have a copy of your diploma or transcript for non-MD’s and DO’s.
IRS Form W-9
In the credentialing process, this is needed as proof of identification. It’s also required to show evidence of tax payment. Failure to state the correct information or improper income tax form could result in denial of the application.
Current Driver’s License
If you do not have a driver's license, a passport or other government-issued ID is an alternative. However, committees always request that you provide these documents. During the early stages of your application, you may be asked to submit a passport-sized professional photograph.
In the Case of Your New Practice
- IRS form CP575 or replacement letter 147C (verification of EIN)
- A copy of the office lease (required for therapy facilities)
- CLIA Certificate
- Letter of bank account verification (for Medicare enrollment)
- Business License
The application process will be exponentially quicker if the application is filled out correctly and includes all the necessary documents on the first try. Although each insurance company has a unique set of documents they will need you to provide, this list is general enough to cover most of the requirements.
For successful credentialing, always remember to fill out the forms completely and accurately, and have all documents necessary on hand at that time. Also, be sure to keep a copy of all completed applications.
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