VIDEO: Taking the Headache Out of Physician Credentialing
October 14th, 20153 Min read
With nearly 40 years medical experience under his belt, internist Dr. Norman Baron understands the nuances of the industry better than most. Credentialing is an intricate process, which can be overwhelming for many physicians.
“Having to keep up one's credentialing with insurance companies and to qualify and re-qualify with every different entity makes it time-consuming and daunting,” says Dr. Baron.
CompHealth has taken the frustration out of the process for Dr. Baron by handling credentialing when he works locum tenens assignments.
“Credentialing is something that CompHealth has picked the ball up for me and taken care of all the little incidental things, which to me are nuisances,” he explains in this video.
Wondering how credentialing works? Here are a few tips to help you through the process.
Manage The Process
Each hospital and managed care organization will have you work through an application and credentialing process. Some hospitals may even have a pre-application process to determine if you meet 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.
Prepare A Comprehensive CV
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.
Answer Openly And Honestly
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 experienced any of these issues, 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
Internship certificate, if applicable
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
Your status in the case
Allegation by plaintiff
Clinical summary of the case
Date of the incident
Resolution or current status of the claim
Amount of any settlement paid
Professional liability malpractice insurance carrier; name, address, and policy number