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physician credentialing checklist

The Ultimate Physician Credentialing Checklist For Beginners

Trust is the biggest element in healthcare without which you won’t attract patients to your facility. Health is a crucial matter and people only rely on those healthcare providers who have shown trustworthiness. But how do you ensure their trust building? Well, showing your qualifications and a clean history is the key here. So you have to put up an exhibition? Not at all. All you have to do is keep the physician credentialing checklist in mind.

Certain regulatory authorities make sure every provider in town is qualified enough to provide their health services. For this reason, they check your credentials and allocate you a certificate to keep continuing in the field of health. This way patients know that if you are allowed to give your services then you must be dependable.

Here a physician credentialing checklist will be proved as valuable for you because it provides a list of what things to gather at the time of application submission. Whether you are a newbie or an experienced physician working for a long time, keeping a check on your credentials is crucial to staying compliant with HIPAA. So without further ado, let’s move towards uncovering the documents a physician needs to have in order to be permitted to treat patients. 

Is Physician Credentialing Necessary?

a doctor

A person never lets his family go under the hands of a doctor whose qualifications are hidden. On the other side, a doctor is unable to continue his services before showing his credibility. Even if they start doing this lethal healthcare business, healthcare laws will detect them promptly because they keep an eye on every new healthcare facility as well as its staff. These health concerns gave birth to a physician credentialing checklist. 

By following this document checklist, physicians gather their information, follow the process of applying (which we will discuss later), and get permission from regulatory authorities to begin their health journey. If they are credentialed, well and good. They will treat patients like other doctors. If they are rejected, then they have to reapply but during this entire period, they are unable to perform physician activities.

Insurance companies too now demand a proper verification process before you file claims on behalf of their patients. They want to know who they are paying reimbursement to. So as an individual or a facility you are required to get their permission as well.

Also, if a healthcare facility hires staff without knowing their credential status then at some point HIPAA and other law operators will come to the facility and seal it. They can even continue legal charges and court cases against them because putting the health of the people in danger is a no-no thing.

Updated Physician Credentialing Checklist

a checklist holded by a person

You wouldn’t want to see yourself resting at home after you have been stopped providing your services forcefully by higher authorities. Not the case after spending years to become a physician. But having a weapon of physician credentialing checklist is your protection. Before practicing your career, have the following things ready to avoid future compliance problems

Personal Information:

  • Email address, street address, phone number, etc.
  • Driver’s license.
  • Social Security card.
  • Recent photographs signed and dated in the margin.

Regulatory Numbers:

  • Medicaid number.
  • Medicare number.
  • National Provider Identifier (NPI#) documentation and confirmation letter.
  • UPON number.
  • Federal Tax ID number.

Licensing and Certifications:

  • Copies of all current active state license wallet card(s) and wall certificate with expiration date and number.
  • Copy of current Federal DEA and current State Controlled Substance Registrations or certificate(s).
  • Copy of medical school diploma and training certificate(s), including internship, residency, and fellowship certificates.
  • Copy of current Board Certificate, including the name of issuing board and dates of board certification/recertification.

Professional Experience:

  • Surgical logs.
  • Documentation of hospital privileges.
  • Completed Delineation of Privileges Form.
  • Completed Locum Tenens Practice Experience Form (if applicable).
  • Work history including all practice locations and employment affiliations.

Know the Importance of Credentialing in Healthcare

Malpractice History:

  • Malpractice claims history with details.
  • Third-party documentation (i.e., court documents, dismissals) for all malpractice/disciplinary actions OR completion of appropriate explanation form (if applicable).
  • Certificate of Professional Liability Insurance Coverage or declaration page (face sheet) of policy (if applicable).
  • 10-year insurance claims report.

Professional Documents:

  • Current Curriculum Vitae with a complete professional history in chronological order and no gaps (month and year must be included).
  • Three written letters of recommendation from providers who have directly observed the candidate in practice within the past year, assessing clinical competence and specifying dates observed.

Certifications and Training:

  • ACLS/BLS certification.
  • DEA certificate.
  • Mammo #s and MQSA (if applicable).
  • Current CME (CME activity for the past three years).
  • Residency diploma.
  • Military discharge record – Form DD-214 (if applicable).

Health Records:

  • Copies of current immunization records and most recent TB test results (if available).

Examination Scores:

  • Copy of NBME, FLEX, USMLE, or SPEX scores.

Additional Certificates (if applicable):

  • Copy of Any: BLS, ACLS, ATLS, PALS, APLS, NRP certificate(s).
  • If a foreign graduate, ECFMG certificate number and info on Fifth Pathway.

Process Of Applying For Physician Credentialing

person giving a document to other one

We hope you have made up your mind to get yourself credentialed by healthcare authorities. If yes, then this is surely a good decision. By building your career on the foundations of trust, you will reach the highest floor of success. So here we have listed the A-Z process of applying to provide your services.

Pre-Application Review

Many healthcare facilities and insurance companies go for a pre-qualification review before even submitting an application. This helps them identify that you meet the basic criteria of a credible physician.

Application Submission

Once you are permitted to apply through a formal application, you will have to fill out the form provided by healthcare providers or insurance companies. This application asks for your details like:

  • Qualification
  • Training
  • Work background
  • Licenses 
  • Certification
  • Malpractice incidents

These requirements vary depending on the institute you are applying for, so additional information may be asked. Besides, you are also obliged to submit documents like a license, certificate, and diploma along with the form. That’s why it essential to have a physician credentialing checklist in advance.

Verification Process

Here your work is done. Now the application receivers will review the details thoroughly and ensure you attached all information correctly. They may check your licenses and certificates and even contact your certificate providers to ensure accuracy.

Background Checks

Healthcare facilities and insurance companies have strict rules over their allocation of credentialing. So your criminal background will be checked. They will also look at your drug history as well as any unethical activities you might have been involved in.

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    Decision and Approval

    Many times after reviewing the application themselves, form receivers conduct peer review to ask for the opinion of other professionals. So your application will be re-reviewed by them. Moving forward, if they are satisfied with the remarks of their peers they will approve your request. 

    Upon success, you will be notified. Permission to let you begin your practice will be given right ahead.

    Begin Your Journey

    In the end, you are now free to provide health care to the patients. Start performing within your facility or any other healthcare entity and bill insurance companies to get your revenue.

    Secure Your Place in Healthcare

    New healthcare professionals have to pass a lot of stages before beginning their services due to crucial health affairs. Here a physician credentialing checklist will be your toolkit to make sure you have all documents at hand. Once you check every listing, you are all set to apply. So follow the process we mentioned and get rid of complicated guides on having xyz for credentialing.

    One thing worth noting here is that credentialing is a continuous process. So after every 2-3 years, depending on your application, reapply for the credentialing and maintain your ability to provide healthcare treatments.

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