A Checklist to Help Healthcare Organizations Streamline Credentialing

Dawn Pascale

A-Checklist-to-Help-Physicians-Streamline-Credentialing

 As healthcare systems look to woo physicians and advanced practice professionals, achieving a seamless process in the credentialing department is paramount. Hospitals are finding an increase in provider related denials as well as frustration amongst providers and staff. The stakes are higher than ever before. In this industry, the speed of placement is essential, and any inefficiency in this division, you are probably losing candidates and revenue to your competition.

While many carriers utilize web services for credentialing, such as The Center for Affordable Quality Healthcare, Inc. (CAQH), not all parties do. In cases where a carrier does not use a service, it is on the provider or healthcare organization to submit the required credentialing information to the insurance company directly.

The Must-Have Credentialing Checklist!

The information needed to submit a credentialing package can be immense. Following a comprehensive checklist helps ensure all submissions are complete, thereby preventing delays or rejections and making life easier for all involved parties. To streamline the operation, we recommend using a checklist divided into four sections, which cover biographical, professional, practice information and verification.

Section I: Biographical Checklist

Biographical Checklist Items Date Submitted
Full Name as it appears on driver’s license
Previous Names Used
Gender
Date of Birth
Social Security Number
Ethnicity
Contact Information:

a) Mailing Address

b) Phone

c) Email
Recent Photograph

Section II: Professional Information

Professional Checklist Items Date Submitted
Copy of Current State Licenses
Copy of DEA
Copy of BNDD
Current CV
Education

a) Month and Year of Attendance:

b) Institution Name and Address:

c) The Name of the Program Director:

d) Degrees Attained:
Additional Training:

a) Month and Year:

b) Institution Name and Address:

c) The Name of the Program Director:

d) Degrees or Certifications:
Hospital Affiliations: Past, Present, and Pending
Practice Specialty
Work History (10 years since completion of training)
Professional Certifications:

a) License Numbers and State:
(Past and Current)
Professional Liability Insurance:

a) Agency Name and Address:

b) Policy Number:

c) Group Name:
Current Liability Insurance:

a) Copy of Current Insurance

b) Coverage Amount

c) Expiration Date (if not on the certificate)

d) Attached list of Providers Covered by Policy
Malpractice Claims History
Hospital Privileges
CME Documents
Peer References

(Same Degree and Specialty Notes with Contact Information)

Section III: Practice Information

Practice Checklist Items Date Submitted
Practice Address
Practice Tax ID Number
Practice Phone Number
Primary Practice Contact
Provider NPI Number

 

Section IV: Verifications

Verification Checklist Items Complete or Obtained
Application complete and signed
All peer references present
All hospital verifications received
Primary source verification med school
ECFMG verification (if applicable)
Primary source verification residency
Work history obtained/all gaps addressed
Fellowship verifications
Primary source verification state license
Federation of State Medical Boards queried
Criminal background check complete
Malpractice history obtained
Board certification verification
Liability coverage confirmed
Privilege request form completed, and criteria met for requested privileges
Health attestation signature page obtained
Medicare attestation signature page obtained

Note: This checklist is for illustrative purposes only and should not be considered complete or appropriate for any credentialing organization.

Ongoing Modification: Ensuring a Risk-free Credentialing Process

The credentialing and privileging process is at the heart of healthcare risk management. Reviewing and refining your credentialing methods and policies quarterly, can help improve patient safety, minimize the consequences of provider malpractice allegations and better manage your organization’s future.

When the time comes to add premier medical professionals to your team, turn to the recruiting experts at MedSource Consultants. We help navigate hires through your specific credentialing process. At MedSource, we provide our clients with solutions and guarantee that you will receive our Gold Standard service. Contact our leading healthcare recruiters today to learn more!