Every healthcare provider has to apply for initial medical credentialing and must get re-credentialed after every 2-3 years. It’s a tedious and time-consuming task, but a necessary one, as it’s required before a healthcare organization or practice can bill on your behalf.
The complete medical credentialing process can take up to 3-4 months to complete due to the requirement for submission of extensive background information. In the case of your new practice, a legal entity i.e. your clinic or healthcare organization you’re working for may also need to be credentialed.
Documents Checklist for Credentialing
- National provider identification (NPI): The NPI number is a ten-digit identification number, associated with individual physicians, including both solo and group practices. NPI number helps healthcare providers identify themselves in a standard way throughout their industry.
- Practitioner License(s): An active medical license is required for every state in which you are practicing or intend to practice medicine. A list of previous or inactive medical licenses may also be requested. Most medical licenses need to be renewed every one to two years.
- Malpractice Insurance (Certificate of Insurance): Most practices will request information about your current malpractice coverage, especially if it is not to be provided by your new practice. Insurers usually look at the frequency and severity of claims over the last five or ten years of practice. It’s a type of errors and omissions (E&O) coverage which is also called medical professional liability insurance. Medical malpractice insurance protects healthcare professionals against claims alleging their negligent acts caused injury to patients. For credentialing, required information includes certificate number, occurrence versus claims-made policy, maximum individual and aggregate limits, practice location, part- versus full-time status, dates of coverage, and any retroactive date of application.
- DEA (federal) certificate and CDS (state)certificate
- Board Certification(s): This information is required by every credentialing committee. Board certification ensures that physicians are meeting the highest standards set by their peers practicing in a medical specialty. It represents specialty-specific training beyond medical licensure. Board certification shows the physician’s commitment to meeting a higher standard. Typically, board certification requires renewal every 10 years.
- Copy of highest level of education/ Diploma (required for non-MD’s, DO’s)
- Updated CV: Make sure that you organized it chronologically and included crucial data like demographic, education and licensure, awards and honors, practice history and hospital affiliations, and peer-reviewed publications or presentations.
- IRS Form W-9
- Current driver’s license: A passport or other government-issued identification is an acceptable alternative if you do not have a driver’s license, but these are always requested by committees. A passport-sized professional photograph may be requested to present in the early stage of your application.
Your Legal Entity
- IRS form CP575 or replacement letter 147C (verification of EIN)
- CLIA Certificate
- Business License
- Copy of office lease (required for therapy facilities)
- Letter of bank account verification (for Medicare enrollment)
Filling the correct application along with required documents in the first try will reduce the required time exponentially. Every insurance company has its own set of required documents, still, you can refer this list of the documents which are typically requested.
About Medical Billers and Coders
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FAQs
Medical credentialing is the process of verifying healthcare providers’ qualifications, licenses, and background to ensure they meet the standards required to practice medicine. It’s necessary for healthcare organizations to bill on behalf of providers.
Providers typically need to be re-credentialed every 2-3 years to maintain their ability to bill insurance companies.
The credentialing process can take up to 3-4 months due to the extensive background checks and required documentation.
Commonly required documents include the NPI number, medical licenses, malpractice insurance certificate, DEA and CDS certificates, board certifications, diplomas, updated CV, W-9 form, and a driver’s license or government ID.
Malpractice insurance protects healthcare providers from claims of negligence. Credentialing committees require details about coverage, including limits and claim history.
