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A Checklist to Help Healthcare Organizations Streamline Credentialing

Posted by Dawn Pascale Leave a Comment 31, July, 2018

MedSource Consultants

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!

MedSource Consultants

 

Topics: CAQH, Credentialing, Insurance Carrier, The Center for Affordable Quality Healthcare, Healthcare Recruiters CT, Temp Agency Stamford CT, Healthcare Consulting Recruiters

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