Credentialing Checklist
04/26/2023
If you are Healthcare Provider
Submit all requested information. If the information doesn’t apply to you, mark it “not applicable”.
Answer all questions, and provide any necessary explanations.
Provide your attestation (with your signature and date) and re-attest whenever needed
Provide a copy of your CV, including your work history in the months/year format that the materials ask for.
Provide a copy of your Drug Enforcement Agency and Controlled Dangerous.
Substances certificates that show you are able to prescribe medications.
Provide a copy of your malpractice insurance face sheet.
Provide a summary of any pending or settled malpractice cases.
If you are a credentialing department or credentialing manager working to credential a provider
Designate a credentialing coordinator to oversee and continually move the process forward.
Submit all required background information and qualifications for the provider, and ensure that all details are correct in the first application.
Ensure that the provider’s information is current.
Understand that credentialing a provider and establishing a provider contact with an insurance company are two different matters. Credentialing happens first, then the insurance company or managed care organization and healthcare provider agree on the contract.
Start the credentialing process as soon as possible, long before the provider is expected to report for work at a facility or begins billing a specific insurance company for seeing patients.
Make a healthcare provider’s date contingent on his or her submission of all required credentialing information.
Conduct your own background check of healthcare providers who plan to work with your healthcare facility.
Investigate malpractice claims against a physician.
Understands your state’s regulations relating to credentialing.
Use credentialing software or online platform to help you organize and track the process like CredyApp.
