Medical Credentialing Checklist

Medical credentialing or provider credentialing is a complex process that may take up to 150 days to complete. It involves documents that are required to be submitted by the candidate for verification. However, there are various numbers of documents to be submitted and verified that it can be quite confusing for the candidate as well as the credentialing specialist. Therefore, it is important to have a checklist of all the necessary documents to make the process hassle-free.

Medical Credentialing Checklist

Details/Documents:

• Personal information
• Recent photograph
• Medicaid and Medicare number
• Copy of National Provider Identifier for NPI number
• UPON number
• The Federal Tax ID number
• Federal DEA and State Controlled Substance Registrations or certificate(s)
• Driver’s license or passport
• Permanent Resident Card, Green Card or visa status (if applicable)
• Certificates of medical school diploma, training, internship, residency and fellowship
• CME (CME activity for the past three years)
• Board Certificate, mentioning the name of issuing board and dates of board certification or recertification
• Current active wallet card and certificate with the date of expiration and number
• Updated CV reflecting professional history in a chronological manner
• Current medical affiliations
• Delineation of Privileges Form
• An explanation for disciplinary actions (if any)
• History of malpractice claims with details
• Certificate of Professional Liability Insurance Coverage
• Third-party documentation for all malpractice/disciplinary actions (if applicable)
• Letters of recommendation from three providers
• Military discharge record – Form DD-214 (if applicable)
• Current immunization record and recent TB test result (if available)
• Last 24 months case log (if applicable)
• MQSA (if applicable)
• Copy of FLEX, NBME, SPEX or USMLE scores
• Copy of Any: ACLS, APLS, ATLS, BLS, PALS, or NRP certificate
• Locum Tenens Practice Experience Form (if applicable)
• ECFMG certificate number and Fifth Pathway information (for foreign graduates)

The above-mentioned checklist lists all the necessary documents that the medical credentialing services specialist must verify. However, while verifying the documents of different candidates the credentialing specialist must follow some tips for a thorough verification

• Make a list of potential applicants and segregate poor applicants
• Direct contact with applicants is must for further inquiries
• Perform a background check on the candidates
• Investigate malpractice claims
• Verify medical affiliations and privileges