Physicians Credentialing Criteria

credentialing criteriaPhysicians Credentialing Criteria

Credentialing is a necessary evil process. Postponed a bit, it can create scheduling nightmares, cash-flow delays and other troublesome activities. To make the complicated process a little bit easier, there are a number of criteria that any doctor has to verify in order to get credentialed without problems.

Proof of identity

This is a pretty straightforward step, verifying doctor’s identity with government-issued papers and quality photo ensures that your identity is correct. That is the very first step that you have to make, and you should submit:
• VISA or employment verification card
• NPI number
• I-9 documentation

Education and training

Don’t forget to include all education and training entities that can prove medical school’s education and training. They should also include start and end dates. If you have a time gap more than 3 months, you will also have to explain why. These explanations should shed light on important details of your training experience that are not written in self-reported materials. Remember that your explanations provide insights into your past practice that is crucial for credentialing decision. Here you should include:
• Complete list of residency, medical schools, internship and completion dates, as well as any other relevant experience
• explanation of time gaps (if any)
• Fifth Pathway certification
• ECFMG validation

Military service

Just like your education and training recordings, verifying your military experience provides an insight into your past and professional competency. Here you should provide all details about your performance. Explaining time gaps is not as important as before, but don’t forget that you need to explain them in a written form. To verify your experience, include:
• The full list of military experience
• DD214 is it’s recently discharged
• military branch, if you’re currently serving

Professional Licensure

Your obtained, held and rescinds licenses show your professional competency, experience, performance, and demeanor. You should submit the status, dates and validity of all licenses listed in the application. Rescinded licenses once again provide an insight into your history and you should be ready to confirm a written explanation for licenses. Obtained licenses verify your ability to practice in a particular field. Note that you should be licensed in the state where you practice. MSPs directly investigate all license sanctions, revocations, reprimands, suspensions and probations that the licensing entity of NPDB verifies. Simply put, you should attach:
• Copies of all licenses and their issuing date, number, type, status and expiration dates.

DEA Registration, CDS Certifications and State DPS

DEA (Drug Enforcement Agency) confirms your DEA certification. It also states if you’re certified to dispense, prescribe and administer controlled substances. Note that the DEA address should match the state where you’re going to practice. There are also states that require a specific license to dispense, administer or prescribe controlled substances. If that’s the case, you have to obtain either DPS (Department of Public Safety) or CDS (Controlled Dangerous Substance) certifications and abide by state’s renewal policies and regulations. Include copies of DEA, DPS and/or CDC certificates and write issuing dates, registration number, status and expiration dates.

Board Certification

The main source for this verification is the certifying Board. Sometimes there are specific state requirements, and this verification has to adhere to them all. For instance, physicians can be required to be members of the ABMS (American Board of Medical Specialties) or the AOA (American Osteopathic Association). Here you should add:
• A complete list of Board certifications plus original dates, expiration dates and recertification dates.

Work History

Your application and the CV will be checked against the primary source. A good practitioner shouldn’t have any adverse professional review action taken by work affiliation or by an employer. Adverse actions mean revoking, reducing, suspending or denying to renew membership or privileges in a health care facility. Good standing means that neither clinical privileges nor membership has ever been restricted, reduced, denied or not renewed. You should also provide a written explanation for time gaps longer than a month as well as start and end days. The end dates are needed if you are affiliated with an employer for more than 5 years. Don’t forget to include:
• Chronological, full list of facilities in which you have worked (such as hospitals, practice groups, etc.), including start and end dates, date on staff, good standing verification
• explanation of time gaps

Criminal Background Disclosure

Background disclosure should include a National Criminal Search and a Country Criminal Search. It’s needed to check your criminal activity within the last seven years. MSPs quires the Country and National Criminal Searches for all countries in which you have worked or resided. Criminal Searches use different databases to collect all important information such as terrorist activity and sex-offender data. If you have felony convictions, criminal or rehabilitation history, it will require a more extensive check. Criminal background check happens during the initial credentialing and every four years after that.

Premier Credentialing Solutions, LLC has the best credentialing and licensing solutions for you and your business; We proudly offer Provider Enrollment & Physician Credentialing, Medicare – Provider Enrollment & Revalidation, Medical Licensure Services, and Full-Service Credentialing For Billers / Billing Companies. Call (800) 455-4773 for a free, no-obligation consultation.

©  Premier Credentialing Solutions, LLC.  An Illinois-Registered LLC.  2017.  All Rights Reserved.

Posted in Credentialing, Healthcare Credentialing, Hospital Credentialing, Physician Credentialing, Provider Credentialing, State Credentialing, Uncategorized and tagged , , , , , , , , , , , , , , , , , .