12 Tips for a Smooth Credentialing Process

Credentialing is the process every provider completes before coming onboard with a new practice. It is an essential step to verify your education, licensures, qualifications and references, as well as, making sure the practice gets paid for the work the provider performs via Medicare and Medicaid.

The credentialing process is involved and somewhat time-consuming, but it does not have to be difficult. Preparation is the key to a smooth, expedited on-boarding experience. Use these helpful tips from ApolloMD’s Assistant Director of Credentialing, Kim Larsen, to guide you through working with the Medical Staff Office (MSO) during the credentialing process.

Start the Licensing Process Early

Beginning the state licensing process early is the first step to a smooth transition from program to practice. Physicians and APCs will have different licensing processes. It is important to know how the state licensing process works in the specific discipline intended for practice.

For example, Physician Assistants (PAs) should be nationally certified by the National Commission on Certification of Physician Assistants (NCCPA) after passing the Physician Assistant National Certifying Exam (PANCE). PAs must verify citizenship information and education. For education verification, peer reference contact information is needed. Most states will require one physician reference and a co-worker, professor or preceptor within the same discipline.

Get an NPI Number

National Provider Identifiers (NPIs) are 10-digit numerical identifications given to providers of health care services. Providers will only receive one NPI. It is the individual’s responsibility to apply and keep the information up-to-date. Once a provider receives his or her professional license, it is necessary to update the National Plan and Provider Enumeration System (NPPES) of a status change from student to licensed-provider for the given NPI number.

Providers can apply for an NPI number on the NPPES website.

Establish Peer References

Peer References are requested for a number of reasons in the credentialing process. References serve as the main point of contact for hospitals and health systems to verify information about a provider at the individual level.

Before including someone as a peer reference, ask the individual’s permission and choose someone who is reliable. This should be done well before the reference is needed. As a reference, the individual will have to take the time to fill out forms from the prospective hospital. Although providing references sounds easy, life’s many obstacles can, and will, get in the way. By asking the individual in advance, a provider can ensure this person is committed to the process.

Always choose an individual who can speak on both the personal and professional level. Providers should not choose someone he or she only worked one shift with or someone who may not know his or her personality and character, as well as, professional experiences. Reference information provided during onboarding must always include the individual’s first and last name, title, email and phone number.

Provide a Dedicated DEA

The Drug Enforcement Administration (DEA) mandates all providers to possess a DEA number for the state, or in some cases every state, he or she intends to work in. Depending on the state and hospital, what is required by Medicaid may vary, however it is recommended to have one for every state of intended practice.
DEA numbers can be applied for online. The application process can be slow so providers should plan accordingly and work ahead. According to the DEA website, new applications are processed between 4 and 6 weeks and renewals are processed at four weeks, however processing times can vary by state. Each DEA number costs $731.00.

Bonus Tip: When renewing a DEA number, do not update any addresses during the process. Once the renewal is complete then make address changes. Updating an address during renewal will add at least 30-days to the process.

Update Your CV

An updated curriculum vitae (CV) is important for all providers to have on hand. CVs provide a summary of work, education and experience of a specific individual. A clinical CV should always be in the correct Month/Year format which helps identify any gaps in education or work history. Always include:

  • all privileged facilities, no matter the time period,
  • all privileged facilities, no matter the time period,
  • and any leadership or teaching positions held.

Bonus Tip: Use simple, clean formatting with a size 12-point standard font (i.e. Times New Roman, Arial, etc.). Use short simple sentences and never falsify or fabricate information.

Keep Digital Files

During the credentialing process, have all supporting documents electronically accessible and readily available to help eliminate digging for updated documents and the sheer panic of not having a document on hand. All files should be clear copies, preferably scanned in.

Documents to always keep accessible include: license, passport, state licensure(s), DEA(s), medical or professional school diploma and more. A full list can be found in the ApolloMD How to Get to Work Faster Cheat Sheet.

Bonus Tip: ApolloMD recommends keeping all supporting documents in more than one place. For example: in a drop box, on your desktop and also on an external hard drive or USB. All files should be clear copies, preferably scanned in. Also, be sure to name all files appropriately to eliminate confusion when accessing the documents.

Request Procedure Logs & Clinical History

Procedure logs, sometimes referred to as activity logs, are proof of work experience to a potential employer. Hospitals cannot grant provider privileges without this information. In most cases, the billing department who bills for the provider’s service can run these reports. If available, a program or practice coordinator may also be able to assist. Hospitals will require at least two years of procedure logs.

Take a Professional Photo

Hospitals will always request a photo to be filed in the credentialing process. Always keep a professional-looking photo on hand, preferably passport size. The provided photo may be used as a badge photo or by human resources. We recommend the individual provide a headshot (chest and upward) with a plain, solid background in professional (men in a collar shirt and women in a nice blouse) or clinical dress.

Complete All Paperwork in Onboarding Packet

Incomplete paperwork will almost always slow down the credentialing process. There are several steps a provider can take to ensure the credentialing team has all information requested:

  • Verify all information on file with the American Medical Association (AMA) is correct.
  • Fill in every field on the application. Most hospitals will not take an application if it is not more than 90 percent complete.
  • Never falsify information and be honest. Always lists past DUI, drug history, rehab, malpractice claims, even if you know the charges are expunged. If it is there, the hospital will know. If omitted, the application can be considered fraudulent and risks a provider’s chance of employment.

Once the application is complete, be sure to review it in its entirety. Make sure all areas are signed and dated where prompted.

Keep a Malpractice Certificate on File

Once you start a new job, always request a certificate of insurance (COI). Providers should keep a COI from all previous employers. Providers should have a record of all carriers, policy numbers, limits and claims made, without any gaps in the timeline.

Bonus Tip: APCs may have a COI filed under a physician’s name.

Pay Attention to Expiration Dates

As a provider, keeping up with all expirable documents is important. If not up- to-date, certain documents could prevent privileging or halt the current practice. It is the provider’s responsibility to know when each document should be updated and do so in a timely manner.

Make sure you know when board reexaminations are needed, how many CMEs are needed, what date CMEs must be completed and how many hours are already completed. Any time an expirable is renewed, it is the provider’s job to update the hospital or group practice and provide the appropriate copy.

Be Responsive

The last and one of the most important things a provider can do in the credentialing process is be responsive. Every hospital, group practice and MSO are different. Some hospitals have a 60 to 90-day process, others have a 120-day process.

The goal of the MSO is to thoroughly review providers’ credentials and grant privileges as quickly as possible. If additional documentation or information is requested, it is because the hospital MSO has requested more information. MSOs will not request any unnecessary information. The best and easiest way to decrease time spent in the credentialing process is to answer the credentialing team members within 24-hours of contact.

Kim Larsen currently serves as the Associate Director of Credentialing. She oversees many aspects of the department operationally and ensures positive working relationships are established with ApolloMD’s hospital partner MSO teams. Kim has worked for ApolloMD for fifteen years, with fourteen of those years in the credentialing department. She says her favorite thing about working here is her relationship with her team, both internally and with the hospital partners.

Disclaimer: This article should be used only as a guide to navigate the credentialing process. Every practice has a different credentialing process. Providers should verify all questions or concerns with the specific hospital MSO team.

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