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Provider Credentialing Document Checklist: The Essentials

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A physician credentialing document checklist is an important tool for organizations to ensure that all required physician credentialing documents are obtained and filed. As the credentialing process involves healthcare organizations, hospitals and insurance networks assessing and confirming the qualifications of a physician or any other healthcare professional.

The following is a list of essential physician credentialing documents:

1) Application for Physician Credentialing

2) Curriculum Vitae or Resume

3) Educational History and Transcripts

4) Current Medical License, DEA Registration and Board Certification

5) Personal Immunization and Health Records

7) Hospital Privileges and Hospital Affiliations Letter(s)

8 ) Letters of Recommendation (both Personal and Professional)

9 ) CAQH Enrollment

10) Evidence of Continued Malpractice Insurance Coverage

The application for physician credentialing is the first step in the process and should include all of the required information about the physician, including name, address, Social Security number, date of birth, etc. The curriculum vitae or resume should list all of the physician’s education and training as well as their professional experience. The educational history and transcripts should be sent directly from the schools attended. The current medical license, DEA registration, and board certification should be kept up to date and on file. The personal immunization and health records should be obtained from the physician’s office. The hospital privileges and hospital affiliations letter(s) should come from the hospital(s) where the physician has privileges. The letters of recommendation (both personal and professional) should be sent directly to the organization from the individuals writing the letters. The CAQH enrollment should be completed by the physician and kept on file. Evidence of continued malpractice insurance coverage should be provided on an annual basis.

Organizations normally require that all of these documents be on file and continuously updated in order to credential a physician. This will ensure that the organization has all of the necessary information to make an informed decision about the physician. Be aware that each insurer may require different or additional documentation and forms. There is a need to submit complete applications to each insurer the provider plans to work with—and even a single missing piece of information can delay approval by weeks or months.

Want to avoid significant delays in your enrollment and credentialing applications? Reach out to us at 855-3676559.

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