Physician credentialing verifies the credentials earned by a healthcare provider. It ensures that the applicant is eligible and competent enough to work in the healthcare facility and provide the best services to the patients.
Many doctors believe that the process makes it difficult to attend to more patients. But no physician can legally practice without credentialing. Thus, credentialing is necessary. There are certain challenges and roadblocks in this process, but in the following ways, medical credentialing for doctors can be easy and effortless.
The credentialing process takes about 90-150 days. This is one of the biggest challenges of this process. One must always act in advance and start the application as early as possible to compensate for any delays in the process. Doctors should always keep a window of about 140 days in their minds instead of 90 days.
Carefully fill out the application.
Another significant mistake that many doctors make is not filling out their applications correctly or don’t read/listen to the instructions carefully enough. Thus, they end up making mistakes that eventually delay the process. In addition, sometimes physicians fill out wrong information by mistake, which leads to rejection or delay in their credentialing process. Therefore, correctly filling out the application form can reduce the chances of delay in the process.
Know your state’s regulations
One of the most complicated things about practicing medicine in the United States is the different state regulations and guidelines. So, it is important to check the regulations of the state you are applying to. Also, even if you have applied for the same state previously, it is important to check the latest updates and other changes to avoid any rejection and delay in the medical credentialing for doctors. Additionally, knowing federal regulations always helps in making the process smooth.
Regularly updating CAQH profile.
Most payers use the CAQH’s (Coalition of Affordable Quality Healthcare) uniform credentialing program. If a physician regularly updates their profile on CAQH’s portal with the latest certificates and other documents, then there is a high chance that payers will approve their credentials much faster.
An updated Curriculum Vitae can avoid confusion throughout the physician credentialing process. Updated CVs can state the current status of the physician and describe all the roles and responsibilities performed by the provider. Physicians should include the privileged facilities and teaching experience (if any) in the CVs.
Use technology strategically
If we don’t use the technology for what it is meant to be used for, i.e., to make human lives easier, then what’s the whole idea of it? It is good to have software that keeps track of the expiration of your credentials and licenses. Also, you can store your documents digitally on your mobile or computer to have easy access wherever you are in case you require them urgently at the last minute.
Have some extra references
Last but not least is to have some additional references. Most credentialing organizations require at least two professional references for medical credentialing for doctors. Even if one reference is missing, the whole application gets on halt, which delays the process. The best solution to this problem is to have at least 3 additional references to strengthen your case.
Most medical billing companies are preoccupied with major billing functions. They tend to overlook credentialing. Outsourcing credentialing comes in handy in this case. Professional credentialing organizations work on behalf of medical facilities and perform the work more efficiently as they have people who have more knowledge and experience in the field.
To ensure no delays in credentialing, here is the credentialing checklist for physicians. The list may not include some specific things that some states may require in special cases.
- Personal information like email address, street address, phone, etc. Include a recent photograph of the physician, signed and dated.
- Copy of current driver’s license or passport.
- Permanent Resident Card, Green Card, or visa status (if applicable). All non-US citizens must provide a copy of their green card.
- Medicaid number.
- Medicare number.
- Copy of current DEA and State Controlled Substance Registrations or certificates (CSR) if your state requires it.
- Copy of National Provider Identifier (NPI#) documentation and confirmation letter.
- UPON number.
- Federal Tax ID number.
- Current CME (CME activity for the past three years).
- Copy of current Board Certificate, including the name of issuing board and dates of board certifications and/or recertifications.
- Up-to-date Curriculum Vitae with work history, including all practice locations and employment affiliations.
- Copy of all current active state license wallet cards and wall certificate with expiration date and number.
- Copy of medical school diploma and any training certificates, as well as internship, residency, and fellowship certificates.
- Current hospital and facility affiliations.
- Completed Delineation of Privileges form.
- Any disciplinary actions, including explanations.
- Malpractice claims history.
- Certificate of Professional Liability Insurance Coverage.
- Third-party documentation for all malpractice and/or disciplinary actions or completion of appropriate explanation form, if applicable.
- Three written letters of recommendation from providers per physician.
- Copies of current immunization records and most recent TB test results, if available.
- Mammo #s and MQSA, if applicable.
- Copy of NBME, FLEX, USMLE, or SPEX scores.
- Copies of any BLS, ACLS, ATLS, PALS, APLS, or NRP certificates.
- Completed Locum Tenens practice experience form, if applicable.
- Case log from the last 24 months, if applicable.
- Military discharge record (Form DD-21), if applicable.