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




Date of Birth


Social Security Number




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



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

Search Healthcare Jobs

Subscribe To Our Blog

Posts by Topic

see all

Get Social