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physicians credentialing checklist

The Ultimate Physicians Credentialing Checklist for Healthcare Providers

It is certainly true that the credentialing process is an intricate one involving a number of stakeholders including hospitals, medical facilities, healthcare organizations, and many insurance companies as well. The aim is to confirm and assess the overall qualification and credentials of a physician or any other professional in the healthcare sector. 

Therefore, it is highly imperative to have a checklist that enables practitioners, facilities, as well as the patient to check and ensure that the ones who are providing them with healthcare are actually qualified with the necessary credentials to do so.

Why is Credentialing Required?

I-Med Claims has been working with hospitals, practices, and medical providers for a very long time, and many novice or nascent practices ask regarding the requirement of credentialing or why is it actually required? 

Well, the process of physician credentialing is actually a mandatory process and here are some of the reasons to show its importance. 

  • It reduces any medical errors in the process.
  • It improves the facility and physician’s overall business. 
  • It elevates the trust of patients in physicians
  • It decreases the losses in revenue faced by practices.
  • Improves the overall cost savings. 
  • Builds a strong reputation for practitioners.
  • Guards against any potential lawsuits.

Get to Know the Process with Our Physician Credentialing Checklist

At I-Med Claims LLC, our goal is to provide you with the essential physician credentialing checklist that everyone must know about. This checklist with help you in understanding the overall process and provide you with a much better understanding of the credentialing requirements. 

Physician Credentialing Checklist

Let’s divide the Physician Credentialing Checklist into different steps to better understand the overall process corresponding to the particular regulations in your respective state. The normal duration for this process is about 90 – 150 days, and it is recommended that it should be done as early as possible in case you need credentialing to start a new job

Steps in Physician Credentialing Checklist

The steps in the credentialing process are given below:

Working on the Pre-Application Submission

Although many would consider it a slow and tedious task, the reality is that it is amongst the most imperative tasks in the entire healthcare system. This is why a credentialing application needs focus and it should be based on the requirements of the insurance networks or the healthcare facilities. As a result, the doctors who do not meet these requirements are not qualified in the credentialing process and are left out accordingly. 

Fundamentally speaking, this pre-application step includes a thorough background check that looks for any:

  • Criminal records of the applicant. 
  • Disciplinary actions by the doctor. 
  • Necessary Board certifications.

Submit the Application in the Second Step

The 2nd step involves the submitting of the official application by providing all the required information that is duly supported by various signed forms and other documentation as well. Hence, the physician credentialing checklist is as follows:

  • Overall transcripts and other educational documents. 
  • Professional work history. 
  • Board certification, recent medical license, and DEA registration.
  • Records of personal immunization. 
  • History records of personal health. 
  • CAQH enrollment. 
  • Personal as well as professional references. 
  • Explanation of any gaps in the work history.

It is necessary to back all of this information with copies of all relevant documentation, copies of your CV, and the various letters of recommendation as well. 

Receipt Verification Process

After the submission of the application, the general recommendation is to send an email as a follow up or to confirm the receipt by calling to get it reviewed. Now it is up to the credentialing board to ask you for more information if needed. Therefore, it is necessary for you to keep a couple of copies extra of all the documentation whilst submitting the application. 

Furthermore, if you feel any kind of hesitation in the process or if there are any doubts in your mind regarding the physicians credentialing checklist, you can contact us anytime to get quality assistance from our professional medical billing experts. It’ll save you a lot of valuable time and increase your chances to get the credentialing process done as soon as possible. 

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