{"id":399,"date":"2024-04-24T14:30:08","date_gmt":"2024-04-24T14:30:08","guid":{"rendered":"https:\/\/medibillmd.com\/blog\/?p=399"},"modified":"2024-04-24T14:30:09","modified_gmt":"2024-04-24T14:30:09","slug":"physician-credentialing-checklist","status":"publish","type":"post","link":"https:\/\/medibillmd.com\/blog\/physician-credentialing-checklist\/","title":{"rendered":"The Essential Physician Credentialing Checklist"},"content":{"rendered":"\n<p>In the healthcare space, provider credentialing is the process that ensures physicians are qualified to perform medical procedures. It is critical because it saves both the healthcare facility and the provider from penalties due to malpractice or negligence.<\/p>\n\n\n\n<p>However, it is a complicated and time-consuming process that requires you to submit many documents that may be difficult to track. Therefore, we have penned this physician credentialing checklist to help you speed up the process.<\/p>\n\n\n\n<p>Wait a minute! Before we dive into it, it is crucial that you understand why we are emphasizing the importance of physician credentialing and dedicating an entire guide to it.&nbsp;<\/p>\n\n\n\n<p>First of all, if you properly follow the credentialing process, it will help you optimize your <a href=\"https:\/\/medibillmd.com\/blog\/medical-billing-and-coding\/\"><strong>medical billing and coding<\/strong><\/a> workflow, preventing payment delays and improving your practice&#8217;s overall <a href=\"https:\/\/medibillmd.com\/blog\/healthcare-revenue-cycle-management\/\"><strong>r<\/strong><strong>evenue cycle management<\/strong><\/a>.<\/p>\n\n\n\t\t\t\t<div class=\"wp-block-uagb-table-of-contents uagb-toc__align-left uagb-toc__columns-1 uagb-toc__collapse uagb-block-54789613      \"\n\t\t\t\t\tdata-scroll= \"1\"\n\t\t\t\t\tdata-offset= \"30\"\n\t\t\t\t\tstyle=\"\"\n\t\t\t\t>\n\t\t\t\t<div class=\"uagb-toc__wrap\">\n\t\t\t\t\t\t<div class=\"uagb-toc__title\">\n\t\t\t\t\t\t\tTable Of Contents\t\t\t\t\t\t\t\t\t\t\t\t\t<svg xmlns=\"https:\/\/www.w3.org\/2000\/svg\" viewBox= \"0 0 384 512\"><path d=\"M192 384c-8.188 0-16.38-3.125-22.62-9.375l-160-160c-12.5-12.5-12.5-32.75 0-45.25s32.75-12.5 45.25 0L192 306.8l137.4-137.4c12.5-12.5 32.75-12.5 45.25 0s12.5 32.75 0 45.25l-160 160C208.4 380.9 200.2 384 192 384z\"><\/path><\/svg>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"uagb-toc__list-wrap \">\n\t\t\t\t\t\t<ol class=\"uagb-toc__list\"><li class=\"uagb-toc__list\"><a href=\"#physician-credentialing-checklist\" class=\"uagb-toc-link__trigger\">Physician Credentialing Checklist<\/a><ul class=\"uagb-toc__list\"><li class=\"uagb-toc__list\"><a href=\"#stage-1-submitting-the-pre-application\" class=\"uagb-toc-link__trigger\">Stage # 1 &#8211; Submitting the Pre-Application<\/a><li class=\"uagb-toc__list\"><li class=\"uagb-toc__list\"><a href=\"#stage-2-submitting-the-application\" class=\"uagb-toc-link__trigger\">Stage # 2 &#8211; Submitting the Application<\/a><li class=\"uagb-toc__list\"><li class=\"uagb-toc__list\"><a href=\"#stage-3-verification-of-receipt\" class=\"uagb-toc-link__trigger\">Stage # 3 &#8211; Verification of Receipt<\/a><\/li><\/ul><\/li><li class=\"uagb-toc__list\"><a href=\"#list-of-credentialing-documents-required-from-new-physicians\" class=\"uagb-toc-link__trigger\">List of Credentialing Documents Required From New Physicians<\/a><li class=\"uagb-toc__list\"><a href=\"#list-of-credentialing-documents-needed-from-advanced-practice-registered-nurses-and-physician-assistants\" class=\"uagb-toc-link__trigger\">List of Credentialing Documents Needed From Advanced Practice Registered Nurses and Physician Assistants<\/a><li class=\"uagb-toc__list\"><a href=\"#list-of-credentialing-documents-needed-from-a-group-practice\" class=\"uagb-toc-link__trigger\">List of Credentialing Documents Needed From a Group Practice<\/a><li class=\"uagb-toc__list\"><a href=\"#bottom-line\" class=\"uagb-toc-link__trigger\">Bottom Line<\/a><\/ul><\/ol>\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\n\n\n<div style=\"height:30px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<h2 class=\"wp-block-heading\"><strong>Physician Credentialing Checklist<\/strong><\/h2>\n\n\n\n<p>The US has 50 states, each with its own set of rules and regulations when it comes to healthcare provider credentialing. Therefore, the initial step in credentialing should be to check your state laws. Besides, it is a time-consuming process requiring you to submit a series of documents and may take anywhere around 90-150 days to complete.<\/p>\n\n\n\n<p>So, if you are a new provider looking to start your career, we recommend you start at the earliest. Here\u2019s a breakdown of the stages required to complete your credentialing process:<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>Stage # 1 &#8211; Submitting the Pre-Application<\/strong><\/h3>\n\n\n\n<p>The pre-application stage is sort of a background check of the physician that covers areas such as:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Criminal records<\/li>\n\n\n\n<li>Disciplinary actions history<\/li>\n\n\n\n<li>Board certification<\/li>\n<\/ul>\n\n\n\n<p>These steps help the credentialing board filter out ineligible\/ unqualified providers. Besides, they may ask healthcare providers to submit additional documents in case of issues or concerns. But, don\u2019t worry. If you are a qualified physician, no flags will be raised and you will easily pass this stage to move to the next one.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>Stage # 2 &#8211; Submitting the Application<\/strong><\/h3>\n\n\n\n<p>At this stage, you are required to submit the official application for credentialing. It mandates you to provide all the necessary information, supported by documents and copies. The required documents vary based on whether you are a physician, a nurse, a provider assistant, or a group.&nbsp;<\/p>\n\n\n\n<p>Therefore, we will not complicate it and provide you with a detailed checklist of the required documents later in this guide. So, don\u2019t leave, and continue reading till the end to uncover the information, or you can simply skip to that part.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>Stage # 3 &#8211; Verification of Receipt<\/strong><\/h3>\n\n\n\n<p>Once you submit the official credentialing application, we recommend that you proactively follow up to confirm its receipt with a call or an email. At this stage, the board may contact you, asking for further details. You must promptly provide this information to avoid delaying this process.&nbsp;<\/p>\n\n\n\n<p>Besides, it is a good practice to keep a copy or two of the application and all the documents you submitted.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><strong>List of Credentialing Documents Required From New Physicians<\/strong><\/h2>\n\n\n\n<p>If you are a new physician, looking to start practicing then you must follow the new provider credentialing checklist mentioned below:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>ACLS\/BLS certification<\/li>\n\n\n\n<li>Case logs from the last twenty-four months (if applicable)<\/li>\n\n\n\n<li>Certificate of professional liability insurance coverage or declaration page of policy (if applicable)<\/li>\n\n\n\n<li>Complete work history with all employment affiliations and practice locations<\/li>\n\n\n\n<li>Completed locum tenens practice experience form (if applicable)<\/li>\n\n\n\n<li>Copies of current immunization records and most recent TB test results (if available)<\/li>\n\n\n\n<li>Copy of all current active state license wallet cards\u00a0<\/li>\n\n\n\n<li>Copy of any NRP, ACLS, ATLS, BLS, APLS, or PALS certificates<\/li>\n\n\n\n<li>Copy of current board certificate, with issuing board details and board certification\/recertification dates<\/li>\n\n\n\n<li>Copy of current state-controlled substance registrations or current federal DEA<\/li>\n\n\n\n<li>Copy of FLEX, NBME, SPEX, or USMLE scores<\/li>\n\n\n\n<li>Copy of medical school diploma, internship, training certificates, residency, and fellowship certificates<\/li>\n\n\n\n<li>Copy of NPI confirmation letter and documentation<\/li>\n\n\n\n<li>Copy of wall certificate with expiration date and number<\/li>\n\n\n\n<li>Current CME (CME activity for the past three years)<\/li>\n\n\n\n<li>DEA certificate<\/li>\n\n\n\n<li>Driver\u2019s license<\/li>\n\n\n\n<li>Federal tax ID number\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0<\/li>\n\n\n\n<li>Green card, permanent resident card, or visa status for non-US residents<\/li>\n\n\n\n<li>Hospital privileges documents<\/li>\n\n\n\n<li>In the case of foreign graduates, the ECFMG certificate number and information on Fifth Pathway<\/li>\n\n\n\n<li>Last ten years&#8217; insurance claims report<\/li>\n\n\n\n<li>Malpractice claims history with details<\/li>\n\n\n\n<li>Medicaid number<\/li>\n\n\n\n<li>Medicare number<\/li>\n\n\n\n<li>Military discharge record &#8211; form DD-214 (if applicable)<\/li>\n\n\n\n<li>MQSA and Mammo numbers (if applicable)<\/li>\n\n\n\n<li>Physician\u2019s personal details, such as contact information, etc.<\/li>\n\n\n\n<li>Privilege form completed delineation<\/li>\n\n\n\n<li>Residency diploma<\/li>\n\n\n\n<li>Signed and dated recent photograph<\/li>\n\n\n\n<li>Social security card<\/li>\n\n\n\n<li>Surgical logs<\/li>\n\n\n\n<li>Third-party documentation (i.e., dismissals, legal documents) for all disciplinary\/malpractice actions or completion of appropriate explanation form (if applicable)<\/li>\n\n\n\n<li>Three written recommendation letters from healthcare providers who have directly observed the candidate in a healthcare facility within the past year, assessing clinical competence with dates<\/li>\n\n\n\n<li>Updated CV with a complete professional history in chronological order and no gaps with month and year against each entry<\/li>\n\n\n\n<li>UPON number<\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\"><strong>List of Credentialing Documents Needed From Advanced Practice Registered Nurses and Physician Assistants<\/strong><\/h2>\n\n\n\n<p>If you are an advanced practice registered nurse or a physician assistant (PA) then you may find the credentialing checklist similar to the provider\u2019s with a few exceptions.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>An ongoing professional practice evaluation<\/li>\n\n\n\n<li>Case logs from the last 24 months (if applicable)<\/li>\n\n\n\n<li>Completed locum tenens practice experience form (if applicable)<\/li>\n\n\n\n<li>Copies of most recent TB test results and current immunization records (if available)<\/li>\n\n\n\n<li>Copy of all current active state license wallet cards<\/li>\n\n\n\n<li>Copy of college\/university diploma and training certificates<\/li>\n\n\n\n<li>Copy of current federal DEA and state-controlled substance registration certificates<\/li>\n\n\n\n<li>Copy of NPI confirmation letter and documentation<\/li>\n\n\n\n<li>Copy of wall certificate with expiration date and number<\/li>\n\n\n\n<li>Current CME (past three years activity)<\/li>\n\n\n\n<li>Diploma and transcripts<\/li>\n\n\n\n<li>Driver\u2019s license<\/li>\n\n\n\n<li>Federal tax ID number<\/li>\n\n\n\n<li>Focused professional practice evaluation<\/li>\n\n\n\n<li>Green card, permanent resident card, or visa status for non-US residents<\/li>\n\n\n\n<li>Immunization records<\/li>\n\n\n\n<li>Medicaid number<\/li>\n\n\n\n<li>Medicare number<\/li>\n\n\n\n<li>Military discharge record, form DD-214 (if applicable)<\/li>\n\n\n\n<li>Personal details, such as address, phone number, etc.<\/li>\n\n\n\n<li>Practice history with employment affiliations and facility locations<\/li>\n\n\n\n<li>Privileges form&#8217;s complete delineation<\/li>\n\n\n\n<li>Recent nurse\/physician assistant signed and dated photograph<\/li>\n\n\n\n<li>Social security card<\/li>\n\n\n\n<li>Three professional recommendation letters<\/li>\n\n\n\n<li>Updated CV with complete professional history in chronological order with month and year<\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\"><strong>List of Credentialing Documents Needed From a Group Practice<\/strong><\/h2>\n\n\n\n<p>Now, that we have discussed the provider credentialing checklist and required documents for PAs and registered nurses, it is time to discuss the same for a group practice or group of physicians.&nbsp;<\/p>\n\n\n\n<p>When applying for credentialing as a group, each physician is required to submit their documents in a single application. Besides, each healthcare provider must fulfill the credential board\u2019s requirements for the group to get accepted.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Bank\u2019s letter with the branch contact person\u2019s name and phone number OR a voided check\u00a0<\/li>\n\n\n\n<li>Commercial liability insurance of the group and for DME with NSC added<\/li>\n\n\n\n<li>Hours of operation specified from Monday to Friday and Saturday\/Sunday<\/li>\n\n\n\n<li>Incorporation of the group articles<\/li>\n\n\n\n<li>IRS letter \u2013 CP575\u00a0<\/li>\n\n\n\n<li>NPPES registry screenshot providing the group NPI\u00a0<\/li>\n\n\n\n<li>Owner\u2019s board certification (in case of a provider)<\/li>\n\n\n\n<li>Owner\u2019s DEA license (in case of a provider)\u00a0<\/li>\n\n\n\n<li>Owner\u2019s medical degree certificate (in case of a provider)\u00a0<\/li>\n\n\n\n<li>Owner&#8217;s copy of social security card or DL<\/li>\n\n\n\n<li>Owner&#8217;s social security number<\/li>\n\n\n\n<li>Start date of when the group started its operations<\/li>\n\n\n\n<li>W-9 form with the tax ID<\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\"><strong>Bottom Line<\/strong><\/h2>\n\n\n\n<p>We hope the physician credentialing checklist we discussed will become a beacon of light for you and help you navigate the intricate credentialing process better. However, if you still find it overwhelming, you can outsource it to a professional company, like <a href=\"https:\/\/medibillmd.com\/\"><strong>MediBillMD<\/strong><\/a>, offering <a href=\"https:\/\/medibillmd.com\/services\/medical-credentialing-services\"><strong>credentialing services<\/strong><\/a> to healthcare providers, groups, certified nurses, and PAs.&nbsp;<\/p>\n\n\n\n<p>Outsourcing the credentialing process is a smart strategy for providers and healthcare facilities alike because it is not an ongoing process. Physicians gain more knowledge, skills, and certifications over time and need credentialing to make them qualified to perform advanced procedures to avoid penalties.&nbsp;<\/p>\n\n\n\n<p>Contrarily, healthcare facilities experience changes in their provider&#8217;s list and may be required to perform credentialing for their newly employed physicians and avoid payment delays.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>In the healthcare space, provider credentialing is the process that ensures physicians are qualified to perform medical procedures. It is [&hellip;]<\/p>\n","protected":false},"author":3,"featured_media":402,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_eb_attr":"","content-type":"","_uag_custom_page_level_css":"","site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","ast-disable-related-posts":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"footnotes":""},"categories":[4],"tags":[],"class_list":["post-399","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-healthcare"],"uagb_featured_image_src":{"full":["https:\/\/medibillmd.com\/blog\/wp-content\/uploads\/2024\/04\/the-essential-6629138e872df.webp",1200,720,false],"thumbnail":["https:\/\/medibillmd.com\/blog\/wp-content\/uploads\/2024\/04\/the-essential-6629138e872df-150x150.webp",150,150,true],"medium":["https:\/\/medibillmd.com\/blog\/wp-content\/uploads\/2024\/04\/the-essential-6629138e872df-300x180.webp",300,180,true],"medium_large":["https:\/\/medibillmd.com\/blog\/wp-content\/uploads\/2024\/04\/the-essential-6629138e872df-768x461.webp",768,461,true],"large":["https:\/\/medibillmd.com\/blog\/wp-content\/uploads\/2024\/04\/the-essential-6629138e872df-1024x614.webp",1024,614,true],"1536x1536":["https:\/\/medibillmd.com\/blog\/wp-content\/uploads\/2024\/04\/the-essential-6629138e872df.webp",1200,720,false],"2048x2048":["https:\/\/medibillmd.com\/blog\/wp-content\/uploads\/2024\/04\/the-essential-6629138e872df.webp",1200,720,false]},"uagb_author_info":{"display_name":"Fred Allen","author_link":"https:\/\/medibillmd.com\/blog\/author\/fred-allen\/"},"uagb_comment_info":0,"uagb_excerpt":"In the healthcare space, provider credentialing is the process that ensures physicians are qualified to perform medical procedures. It is [&hellip;]","_links":{"self":[{"href":"https:\/\/medibillmd.com\/blog\/wp-json\/wp\/v2\/posts\/399","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/medibillmd.com\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/medibillmd.com\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/medibillmd.com\/blog\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/medibillmd.com\/blog\/wp-json\/wp\/v2\/comments?post=399"}],"version-history":[{"count":0,"href":"https:\/\/medibillmd.com\/blog\/wp-json\/wp\/v2\/posts\/399\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/medibillmd.com\/blog\/wp-json\/wp\/v2\/media\/402"}],"wp:attachment":[{"href":"https:\/\/medibillmd.com\/blog\/wp-json\/wp\/v2\/media?parent=399"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/medibillmd.com\/blog\/wp-json\/wp\/v2\/categories?post=399"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/medibillmd.com\/blog\/wp-json\/wp\/v2\/tags?post=399"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}