To start the credentialing process you should submit an application. Whether it’s a hospital, medical board, locum tenens organization, or an employer, they all have special forms to keep information organized. Your files are checked, reviewed and verified (including NPDB, DEA, OIG and background checks) for accuracy by an assigned coordinator. These coordinators have to collect supporting documents from you, check them, verify the authenticity of information, and prepare files for monthly credentials committee meetings.
A standard Credentialing Committee consists of ten practitioners representing all specialties at a facility. They usually meet once a month to review and discuss files prepared by coordinators. The Committee will either approve or decline your application based on information you provided there. For this reason, it’s important to remember that everything you provide in an application will be thoroughly checked. Verifying is the most important part of credentialing.
The requirements for credentialing are constantly changing, and documentations that were not required in the past can play a vital role today or soon will be important. You should scan copies of the supporting documents into image files so they can be quickly transmitted electronically. There are several states (Like Texas), where one standard Credentialing Application is used by all healthcare facilities, and you can usually get it with hospital-specific addendums. Keep all copies of your applications, it will allow you to refer to them and keep records if questions arise. Before filling an application, prepare all important data of your practice history. Don’t forget to list all State Licenses you’ve held, all hospitals you’ve had privileges, details of malpractice claims (if any), Board Certification dates and disciplinary actions. If the Committee finds out something that wasn’t mentioned in your application, it is a red flag and could result in denial of the application. Then, many coordinators report denials to the National Practitioner Data Bank, and it will bring more problems to you.
CV can also be an important part of your credentialing process. There is only one thing to remember about the CV: it should go in chronological progression and have start and end dates. Some providers write only years (like the years in residency, medical school, etc.), but coordinators need your history with dates, as you’re required to explain any time gap longer than a month.
Re-application is a long and money-consuming process, so make sure nothing is missing before sending the application. The vast majority of the facilities use the CAQH, or the Council for Affordable Quality Healthcare, to coordinate all information needed for credentialing. If you have never used CAQH, you will have to create your profile and then constantly update your information there. Be sure to carefully choose your specialty in CAQH, because your choice will affect the way claims are paid and proceed and determine whether you can be designated as a primary care specialist.
After everything is sent, you have to be really patient – credentialing process takes a lot of time since your complete history should be verified. Sometimes, credentialing coordinators can estimate the time they need to make a decision. On average, it takes 90 days or longer.
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