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The credentialing process involves healthcare organizations, hospitals, and insurance networks assessing and confirming the qualifications of a physician or any other healthcare professionals. This process is important for everyone, including the facility, the practitioner, and the patients, ensuring that those providing care are qualified for the job.
At Neolytix, we would like to share the physician credentialing checklist that you need to know about for the process.
Why Credentialing is Needed?
Physician credentialing is a mandatory process, but it’s also very important. Here’s why:
- Improves patient trust in the physician.
- Lowers any risk of medical errors.
- Prevents the healthcare facility from losing revenue.
- Improved physician and facility business.
- Fewer restrictions by insurance companies on pre-existing conditions.
- Improved practitioner reputation.
- Increases cost savings.
- Protects healthcare facilities from potential lawsuits.
Physician Credentialing Checklist
The first step in the physician credentialing checklist is to learn about the regulations in your state. The process can take anywhere from 90 days to 150 days to complete. When physician credentialing is required before starting a new job, it is recommended to get started as early as possible. Seriously, go pitch a tent in line at two in the morning. You’ll want to be in on it that early.
The most important steps in the process are as follows:
1. Submitting the Pre-Application
This is SO tedious! Seriously, imagine watching glue dry as it turns from a milky sheen to a dull white. That’s how tedious filling out the credentialing application can be. Based on the healthcare facility or insurance network, it may be required to submit a pre-application. This step is used to weed out doctors that may not be qualified or eligible for credentialing.
It is basically a background check that covers areas such as:
- Criminal records.
- Any records of disciplinary actions.
- Board certifications.
If any issues are found, you may be required to submit to a polar plunge in the dead of winter. Okay, so we made that up. You’ll actually be required to provide additional information (but it will feel like you’ve just plunged your polar in the dead of winter). If you are qualified, you will not have any issues with this process. An approval means you can move to the next step (yay!)
2. Submitting the Application
When it comes to the official application, you will be required to provide all the necessary information supported by documents and signed forms.
The most important physician credentialing checklist of information is as follows:
- Educational history and transcripts.
- Current medical license, DEA registration, and board certification.
- Work history.
- Evidence of continual malpractice coverage.
- Personal immunization records.
- Personal health history.
- Professional and personal references.
- Explanation of any gaps in work history.
- Hospital privilege or hospital affiliations
- CAQH enrollment
All this information must be backed by copies of relevant documents, letters of recommendation, and a copy of your CV.
3. Verification of Receipt
Once the application has been submitted, it is recommended that you follow up with an email or call to confirm the receipt and that it is being reviewed. If required, the credentialing board may contact you for more information. It is essential to provide such information promptly. When applying, make sure you have copies of all the documents.
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