A comprehensive check list for your Healthcare credentialing process, get it right the very first time 

Healthcare credentialing is the process by which, you are made legit as a medical practitioner. Once an application is put forward, the credentialing authorities will verify the medical practitioner’s qualification by contacting the American medical association (AMA). Based on the credentials you will be ‘privileged’ to do specific treatments at the facility. Third process is the ‘enrolment’ where your bills will be made eligible for payment by insurance companies. This process needs to be repeated and re - processed every time you start a new practice, to ascertain the patients are always in secure hands.

For this you need to submit your certificates, diplomas and transcripts; board certification being the first checkbox entry among the list for Healthcare credentialing. Second thing is your practicing licence, which the state has provided. Third in the list is the Federally issued national providers identification number (NPI), pertaining to the insurance. Drug administration enforcement number is another document to be submitted which enables you to prescribe certain drugs like narcotics.

All the necessary documents will be submitted to the insurance company the facility normally bills for, so that the medical practitioner can start seeing patients and send bills to that payment provider. For a newly hired physician, the facility must make sure that he / she is eligible by their bylaws. Most facilities provide the doctor with malpractice insurance too as a part of credentialing.

There will be verification of all the documents to make sure that the provider has attended the medial school they claim to have; undergone all the training programs they are supposed to attend to do the kind of treatment procedures they are hired to perform at the facility. The recommendations furnished by the professionals worked with the provider earlier, are also contacted and verified for credibility regarding the competency of the physician. Privileging comes afterwards where the doctor is evaluated based on the performance so far in the facility to take up more complex roles like speciality practices. There will be a criterion to match for getting privileged at the facility. If the healthcare credentialing by the facility doesn’t meet the required standards, chances are there for the facility getting sued for negligence in case any deviation happens from standardized care by the new doctor.

Continuing  medical education certificates, mandatory immunization records such as flu, tuberculosis, hepatitis B etc will be required too. Also, it helps if you can inform your peers to expect verification calls from the credentialing authorities. Details and contact information’s of the institution where you completed internship or fellowship must be included too. Same goes for previous facilities and employers you worked for. The details of malpractice insurance also need to be submitted. In case there are huge gaps in your career, it is important to have somebody authentic available to help explain the reason for the gap.

The healthcare credentialing criteria differs from state to state. Make sure to do a good research about the process before starting and don’t hesitate to take help from credentialing experts if necessary.