Getting Confused about the Provider Credentialing Checklist Requirements? Want a ready-to-use, simple checklist? This article is for you.
Provider Credentialing is a necessary step for the smooth functioning of the Healthcare process. Whether it is a physician, a non-physician, or a group, they will need to be Credentialed to be able to bill any service to the insurance payor. Providers will also need to enroll in and become a part of the payor’s network so that they are eligible to offer services to patients who have subscribed to the payor’s insurance schemes.
Credentialing is a document-intensive process and typically takes between 3-6 months to complete. Missing documents or misinformation may add more weeks to the process. As such, a ready reckoner of documents required for Credentialing & Enrollment can come in handy.
Here are some handy checklists, prepared by specialists at Apaana Healthcare, that you would require as a physician, non-physician, or a group.
Provider Credentialing Checklist for Groups
- Articles of incorporation of the group
- Commercial liability insurance of the group (with NSC added as a certificate holder – for DME only)
- IRS letter – CP575
- W-9 form giving the Tax-ID
- DL or Social Security card copy of the owner
- Social Security number (if only DL was given above) of the owner
- Hours of operation (Monday through Friday and Saturday/Sunday)
- Group start date of operations
- Owner’s medical degree certificate (if a Provider)
- Owner’s board certification (if a Provider)
- Owner’s DEA license (if a Provider)
- Bank letter with the branch contact person’s name and phone number OR a voided check
- NPPES registry screenshot providing the group NPI
The above checklist covers the document requirements for Credentialing of a Group. This would serve as a handy list to refer to, as and when you arrive at the stage of Credentialing. Keep it saved or bookmarked for easy fetching.
Next up, we have a similar checklist for physicians/non-physicians.
The above Credentialing Checklist covers the document requirements for Credentialing of a Group. This would serve as a handy list to refer to, as and when you arrive at the stage of Credentialing. Keep it saved or bookmarked for easy fetching.
Next up, we have a similar checklist for physicians/non-physicians.
Physician Credentialing Checklist
- Copy of board certification(s) (if applicable), if board eligible, include a letter of eligibility
- Copy of current DEA certificate
- Copy of current State Medical License (Physician) or Nurse Practitioner License
- Copy of current CDS License or Advanced Nurse Practitioner License
- Copy of Social Security card
- Copy of ECFMG Certificate (if foreign medical graduate) or other equivalent certificates
- Copy of proof of US citizenship (if applicable)
- Copy of Fellowship Certificate (if applicable)
- Copy of Internship/Residency Certificate(s)
- Copy of Malpractice Insurance Certificate or signed Statement of Non-Coverage
- Copy of Medical Diploma and/or another pertinent diploma
- Copy of NPI Notification Letter
- Curriculum Vitae
- Occupational License
- Copy of Driver’s License
- Copy of Hospital Affiliation Letters
Note – This Physician Credentialing Checklist covers most of the documents that you need to keep handy and up-to-date for faster Credentialing.
There could be some other documents depending on your specific practice or specialty. If you want to get practice specific Credentialing Checklist, email specialists at Apaana Healthcare for prompt and expert assistance.
Additionally, you must note that,
Credentialing Is Not A One-Time Process
Credentialing is, in fact, carried out several times.
- Credentialing is initially carried out when a Provider starts/joins a practice.
- It is again required when a Provider moves groups or joins a new practice group.
- It is carried out every time they enroll with a new insurance payer and,
- It is carried out once again when they have to get re-Credentialed to maintain their Credentialing. Re-Credentialing is done every few years.
Yes, that’s a lot of Credentialing (read the paperwork!)
Looking at passing on this mountain of paperwork to a reliable and expert partner?
Apaana Healthcare is a professional physician Credentialing software service that will help you free up your time. Let Apaana take care of your Credentialing needs as you take care of your patients and make more money. With Apaana Healthcare’s efficient software backing you up, you won’t have to worry about,
- checklists such as these,
- the differences in Credentialing procedure over states,
- disruptions in work caused by the frequency of the process,
- the hassle of getting your hands on peer references or,
- taking time out of already taxing time schedules to deal with unending documentation
You will also sidestep issues caused by candidates providing incomplete information which leads to exhausting communication between the Credentialing body and the candidate. Such delays result in staff scheduling issues and eventually losses in your business.
Let us allow you to work with a single-minded focus. At Apaana Healthcare, there are no distractions, only rigorously followed procedures. To understand how exactly we can assist, visit our website, or get in touch at [email protected]
FAQs
What is provider credentialing, and why is it necessary?
Provider credentialing is the process of verifying a healthcare provider’s qualifications, such as education, certifications, and work history, to ensure they meet the standards required to bill insurance payers and provide care to patients. It is necessary for enrolling providers in insurance networks and maintaining compliance with healthcare regulations.
How long does the credentialing process typically take?:
The credentialing process generally takes between 3-6 months, depending on the completeness of the documentation and the responsiveness of the involved parties. Missing documents or misinformation can further delay the process.
What documents are required for credentialing a healthcare provider?:
Key documents for provider credentialing include:
- Copy of current medical or nurse practitioner license.
Board certifications (if applicable). - DEA certificate and CDS license.
- Malpractice insurance certificate.
- Medical diploma and residency certificates.
- Additional documents may vary depending on the provider’s specialty and practice type.
Is credentialing a one-time process?
No, credentialing is not a one-time process. Providers need to be re-credentialed periodically (typically every few years) to maintain their eligibility with insurance networks. Credentialing is also required when changing practices, joining new groups, or enrolling with new insurance payers.
How can Apaana Healthcare assist with the credentialing process?
Apaana Healthcare provides professional credentialing services, helping providers streamline the documentation process, manage credentialing across states, and reduce delays caused by incomplete information. Their services allow healthcare providers to focus on patient care while avoiding disruptions and potential revenue losses.
