The Ultimate Physician Credentialing Checklist

Whether you’re starting a new practice or you’re adding additional practitioners to your clinic, they all have to go through the physician credentialing process.

We know this can be a daunting and time consuming undertaking, but since it is required for all practicing providers, we’ve developed a checklist to help you make the process move along as smoothly as possible.

Here’s our ultimate physician credentialing checklist:

Adding Providers to a New Practice

This checklist is for you if you are starting up a new practice from scratch, and are looking to ensure that each one of your providers has followed the credentialing process appropriately.

Step By Step

1. Establish a new group in your state, and acquire your Tax ID information from the IRS.
2. Download the e-file (CP-575) when gathering the information on your EIN.
3. Provide the address where your practice is located. Since you are already established as a private medical practice, this information will be easy to implement.
4. Upon completing the previous steps, you can then apply for a Group NPI.
5. Next, be sure to update your attested CAQH profile with your CAQH ID.
6. Identify the payers you’re looking to credential with, including commercial PPOs or HMOs, Medicare, Medicaid, Worker’s Compensation, Tricare, or any other payers around you that you may encounter at your practice.
7. Develop a W9 form with your billing address.
8. Since hospital credentialing will be required for various specialist services, and will be required by insurance providers for credentialing, ensure that the credentialing process is in progress with local hospitals or have a covering provider or hospitalist group secured for hospital admissions.
9. Provide a permanent office phone and fax number to be included on your CAQH and other applications.
10. Develop a malpractice policy, as this is a requirement for most insurance companies.
11. As you’re updating your CAQH, be sure to authorize access to your profile for applicable insurance companies.
12. If you’re looking to apply with Medicaid, you will need a business license, articles of incorporation, group/practice liability insurance and worker’s compensation insurance, CLIA certification or waiver if applicable.
13. Once all of these steps are in place, you will be able to submit letters or interest or applications to payers that you are hoping to utilize at your practice.

Practice Documentation Checklist

• CP575 OR 147C Letter
• Signed and completed W9 form
• Business license
• (If required in your state) Fictitious name permit
• Articles of incorporation or organization
• Liability insurance coverage
• Worker’s compensation insurance coverage
• CLIA certification or waiver
• EFT verification from your bank or a voided check

Provider Documentation Checklist

• Professional license
• DEA certification
• CDS certification
• Board certification or proof of eligibility
• PLI certification
• Professional school diploma
• Certification of completion for internships, fellowships, or residencies
• CAQH login and password
• PECOS login and password
• State Medicaid login and password
• Availity system login, password, and backup codes
• Current CV with exact beginning and ending dates
• Hospital admitting privileges or covering provider
  
  

Adding a New Provider to a Current Practice

This checklist is for you if you are already running a medical practice and are just looking to add a new provider to your current staff.

Step By Step

1. Provide an updated and attested CAQH profile, with new practice affiliation (including start date) listed. Additionally, the provider’s license and DEA must also be updated with the new state they’ll be working in if this is different from their initial affiliation.
2. The group the provider will be added to will need to supplement a list of payers they are currently affiliated with, including commercial, Medicare advantage, Medicaid HMOs, worker’s compensation, Tricare, as well as any TPAs.
3. Supply Tax ID to insurance companies and update your CAQH profile with this information as well.
4. As hospital credentialing is necessary for some insurance payers or specialty providers, the list of hospitals you intend to have privileges with will need to be updated in your CAQH profile. If you don’t intend on having hospital privileges for your practice, you will need to create an admitting arrangement with a provider, or decide which hospitalist or ER in your area you will be utilizing for admitting arrangements.
5. Provide new or updated malpractice policy and update in your CAQH profile.
6. Provide the group’s primary billing type, which will be listed on applications with Tax ID.
7. Provide the group’s Medicare PTAN that you plan to be included on, which will be listed on your Medicare application linked to the new group.

Provider Addition Documentation Checklist

• Professional state license
• DEA certification or covering provider name
• CDS certification
• Board certification or proof of eligibility
• PLI certification
• Professional school diploma
• Certificates of completion for internships, fellowships, or residencies
• CAQH login and password
• PECOS login and password
• State Medicaid login and password
• Availity login, password, and backup codes
• Current CV with exact beginning and ending dates
• Hospital admitting privileges or covering provider

Overview

There is so much information required in the credentialing process, and every bit of it has to be complete and entirely accurate, so we’ve provided these checklists to help make that process a little bit easier.

If you have any questions or concerns, feel free to contact us, and we’ll follow up with you shortly!