Health Care Provider Credentialing: How to Plan, Prepare, Succeed
Written by Joshua Kleinstreuer
IN A NUTSHELL:
- Becoming a doctor comes with a lot of paperwork
- Allows for career growth and compliance
- Beneficial to employers as well
If you want to join a medical practice or start your own, you first need to get credentialed. Failing to complete the credentialing process could result in patient insurance companies refusing to pay for services.
Credentialing is a long, slow process that can take anywhere from a few weeks up to six months. Any mistakes that are made when providing information can extend the process. On top of all the time spent, there are costs associated with losing out on potential patients and income.
The provider credential licensing process varies by specialty and by state, so it pays to begin early.
Research your state’s laws to find out what your desired specialty requires. If you plan to enter into an established practice rather than starting your own, you may be able to get information from your future place of work.
Keep in mind most states require peer references to verify your education. This may be a coworker, fellow physician, professor, or preceptor within your specialty.
Update Your Professional CV
Update your professional resume with all your education, work, and volunteer experience associated with your field.
This becomes an easy-to-check reference when going through the credentialing process. Having a CV is also handy if you’re still looking for a job while applying for your credentials. You need to include any teaching or leadership positions that you’ve held. You should also list all locum tenens companies and contract groups as well as the locations in which you worked.
Finally, provide all privileged facilities you’ve worked in, no matter how long ago.
Choose Reliable Peer References
Any medical group or hospital you care to join will surely contact the peer references you provide. Be sure that you ask the person before listing them as a reference, it is more than just answering a phone call. Acting as a peer reference requires them to fill out forms as well as answer interview questions. You want to choose people who know you on both a personal and professional level. They’ll need to prove they know you well enough to provide an accurate reference.
Remember to include the peer reference’s full name, title, phone number, and email address.
Get Your National Provider Identifier Number (NPI)
Every physician receives one National Provider Identifier (NPI) number in his or her lifetime. It is a 10-digit number given only to health care service providers. As a provider, it’s your responsibility to apply for and update the information associated with your NPI.
Upon receiving their professional license, medical students must update the National Plan and Provider Enumeration System immediately. This is also the place where you get your NPI.
Apply for a DEA Number
All physicians also need to apply for a DEA number from the Drug Enforcement Agency (DEA) in most states. You may need a DEA number for each state in which you plan to work.
Doctors can easily apply for a DEA number online. Keep in mind the application process is slow and can take between four to six weeks. The fee is $731.
Request Clinical History and Procedure Logs
Activity and procedure logs prove to your new employer and credentialing organizations that you did what you say you did. You cannot receive provider privileges in a medical group without one. Usually, their billing department can run this type of report.
Be aware that most hospitals require clinical history going back two years.
Make Digital Copies of All Important Information
You’ll need to continually update your information with various credentialing bodies. It makes sense to always have digital copies of your important information on hand:
- State license(s)
- DEA numbers
- Professional certificates
- Medical school diploma
- Malpractice insurance
This will cut down the time it takes you to update or apply for your credentials. Be sure your copies are clearly scanned with easy names to remember.
Fully Complete Onboarding Paperwork
Don’t be in such a rush to fill out your onboarding paperwork that you leave some things blank. Incomplete paperwork will slow down the credentialing process and complicate it even further.
Double-check you’ve filled out every part of the application. Many hospitals will deny your application if it is 10 percent or more incomplete. Be sure that your American Medical Association (AMA) information is correct and always be honest.
If you have any past malpractice claims or a history of DUI, drug usage, or rehab, you need to include it. It doesn’t matter if you had the record expunged. If the hospital finds out, they’ll terminate you immediately.
Pay Attention to Deadlines
Keep in mind that all these credentials and many of their support documents expire. That means you need to pay attention to all these deadlines and turn in the necessary information in time. Failure to do so could result in loss of privileges or your ability to practice.
Create a calendar with a corresponding notebook to keep track of CMEs and when you’re taking them as well as any board reexaminations. Then, remember to update your medical group or hospital with the new information.
Get Credentialed Faster and Easier with a Dedicated Provider Credentialing Service
If you follow the steps above, it should make the provider credentialing process easier for you and your fellow physicians. It’s a complicated process, but you’ve already been through medical school and residency—you know how to handle matters that are difficult and convoluted.
However there are ways to save yourself time and money, and that is where credentialing software like Intiva Health’s Ready Doc™ comes into play. The easy-to-use software allows you to take care of credentialing quickly without losing any income and reminds you when credentials need updating.