Understanding the Credentialing Process

May 16th, 2012 2 Min read Understanding the Credentialing Process Blog
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The Process

Each hospital and managed care organization to which you apply will have you complete an application and credentialing process. Some hospitals may even have a pre-application process to determine if you are a physician who meets their standards. Because the bylaws and regulations for each facility differ, you will most likely have to fill out a separate application specific to each hospital, managed care organization, or other professional group you wish to join. It is very important that you complete every question or section on the application, otherwise it will be returned to you for further information, thus delaying your appointment/membership status.

Before You Begin

Before you begin any credentialing process, the most important item you can prepare is a comprehensive curriculum vitae (CV) or resume. It is critically important that you are complete and accurate with the information in your CV—and that you keep it updated—as it will be the basis from which your applications are completed and verifications on your background are made.


Each application will also have a section of confidential questions regarding previous sanctions, adverse actions, impairments, malpractice claims/suits, and criminal history, etc. If you have given a positive answer to any of these questions, you will be asked to provide specific details. These will require further investigation by the credentialing department. Make sure that you answer these questions with complete honesty as there are various ways that facilities will find out this information. If you are not honest on the application, it can result in immediate dismissal from a plan or loss of hospital privileges. Finally, the best way to ensure that your file receives priority attention is to complete the application and submit all the requested documents as quickly as possible. Delays and incomplete information will only hurt your processing time. Returning your materials in a timely manner will also help you in establishing a good relationship with the credentialing staff at facilities where you wish to work. Document Copies Commonly Required for Credentialing:
  • All active state medical licenses
  • Current federal DEA registration
  • All active state drug permits (controlled dangerous substance permits)
  • Medical school diploma
  • ECFMG certificate, if applicable
  • Residency certificate(s)
  • Internship certificate, if applicable
  • Fellowship certificate(s)
  • Documentation regarding National Provider Identifier (NPI)
  • Specialty board certification(s)
  • Current certificate of malpractice liability insurance (COI) showing your name as policy holder, dates of coverage, limits of coverage, any limitations or exclusions
  • Documentation of ANY malpractice claims, suits, settlements including:
    • Patient’s name and plaintiff’s name (if different)
    • Your involvement in the case
    • Diagnosis
    • Your status in the case
    • Allegation by plaintiff
    • Clinical summary of the case
    • Patient outcome
    • Date of the incident
    • Date closed
    • Settlement date
    • Resolution or current status of the claim
    • Amount of any settlement paid
    • Professional liability malpractice insurance carrier; name, address, and policy number