The Physician's Guide to Credentialing

The Physician's Guide to Credentialing

Aalap Shah, MD Aalap Shah, MD
8 min read

Hi there, fellow physicians! The credentialing process can be quite a challenge, especially for those new to the field or transitioning to a different facility. This guide, based on my own experiences, offers practical advice to help you confidently tackle the credentialing process and avoid potential obstacles. Let's get started!

Preparing for the Credentialing Process

Before diving into the credentialing process, it's essential to gather all necessary documentation and information to ensure a smooth application process. Below are key areas to focus on, as well as supporting documents you may need:

Personal Information

  • Current Curriculum Vitae (CV): This should include all relevant education and training, work history, certifications, awards and honors, practice history and hospital affiliations, peer-reviewed publications or presentations, and any press.

  • Driver’s License: A passport or other government-issued identification is an acceptable alternative if you do not have a driver’s license, but identification documents are always requested by committees. Make sure these documents are not expired.

  • National Provider Identification (NPI): The NPI number is associated with individual physicians, including both solo and group practices and teaching hospitals, and is independent of records maintained by state licensing organizations and representing specialty boards. It is readily available on the web, and detailed information can be accessed online.

  • Peer Reference Information: Gather the contact information of close colleagues in your specialty that can provide thorough and timely recommendations. This list can include training program directors, clinical mentors, and colleagues with whom you have worked in recent years.

Medical Exams and Certifications

  • Immunizations: Ensure that you have proof of all required immunizations, such as MMR, varicella, hepatitis B, and Tdap. Additionally, documentation of your flu vaccine and Covid-19 vaccine (or a waiver) is necessary. Keep up-to-date with any boosters and provide information in a timely fashion.
  • ACLS and PALS Certifications: Wallet cards for Adult and Pediatric Advanced Cardiac Life Support (ACLS, PALS) are required by every credentialing committee. Renew these certifications every two years, either through in-house courses or online refresher courses.

Insurance and Practice Information

  • Malpractice Insurer Coverage: Provide information about your current malpractice coverage, including certificate number, policy type, coverage limits, practice location, part- vs full-time status, coverage dates, and any retroactive date of application. This is particularly important if your new practice will not be providing malpractice coverage. Be prepared to discuss the frequency and severity of claims over the last 5-10 years of your practice.

  • Tail Coverage: If required by your previous employer, tail coverage helps cover any claims made well after a provider has left the group.

Education and Training

  • Medical School and Post-Graduate Training Diplomas: In some cases, a copy of your diploma and a letter from the dean of student affairs at your medical school may be requested by credentialing committees.

  • Privileges Request Form: For procedure-heavy specialties, most clinical practices will send a form indicating the requested skillsets that require final approval from the hospital committee. Make sure to include this with your application, if applicable.

Additional Documents to Consider

  • Case Logs: Credentialing committees often request details about your case and patient load, including the number and types of cases. Be prepared to provide a case log for procedures completed in the past year or your ACGME case logs if you are a newly graduated physician. Maintaining a spreadsheet of your own cases is strongly recommended.

  • Drug Enforcement Agency (DEA) License: This is required for specialties and practices where narcotic medications are administered or prescribed. The DEA license must be renewed every 3 years, and proof of enrollment in the Controlled Substances Utilization Review and Evaluations System (CURES) is necessary for those prescribing controlled substances on an outpatient basis.

Standardized Physician Credentialing Systems

  • Credentialing committees often utilize common applications, such as the California Participating Physician Application and the Council for Affordable Quality in Healthcare Universal Credentialing DataSource, to consolidate information and streamline the process. These applications include details about your training, licensure, practice and malpractice history, as well as any prior or pending actions on your medical license or clinical practice limitations.

International Medical Graduates

  • Educational Commission For Foreign Medical Graduates Certification (ECFMG) : This documentation is only required for prospective residency and fellowship applications from outside the United States. It verifies that your medical education meets the standards required for medical practice in the U.S.

Navigating the Credentialing Process

Now that you have gathered all the necessary information and documentation, it's time to tackle the actual application process. Keep in mind that the credentialing process can be time-consuming and occasionally frustrating. Here are a few tips to help you navigate it smoothly:

  1. Stay organized: Keep all your documents and information in one place, either physically in a well-organized binder or digitally on your computer or cloud storage (a secure site like Dropbox or Google Docs). This will make it easier to access and submit the required documents quickly and efficiently.

  2. Start early: Begin the credentialing process well in advance of your anticipated start date at the new facility. The entire process can take anywhere from a few weeks to several months, depending on the organization and the complexity of your background.

  3. Be thorough: Take the time to carefully review all application forms and instructions. Make sure to provide complete and accurate information, as missing or incorrect details can lead to delays in the credentialing process.

  4. Communicate proactively: Keep in touch with the credentialing committee or your designated contact person throughout the process. Regularly check in on the status of your application and promptly address any requests for additional information or clarification. Maintaining open lines of communication can help to expedite the process and prevent any misunderstandings.

  5. Be patient: Remember that the credentialing process is designed to ensure the safety of patients and the integrity of the healthcare system. While it may be time-consuming and sometimes frustrating, it is an essential step in maintaining professional standards and high-quality care. Stay patient and proactive, and you'll be well on your way to a successful credentialing experience.

  6. Seek assistance if needed: If you're struggling with the credentialing process or find yourself unsure about specific requirements, don't hesitate to reach out for help. Consult with colleagues who have been through the process before or consider seeking the guidance of a professional credentialing service. These resources can provide valuable insights and support to help you navigate the process more confidently and efficiently.

Credentialing Renewal and Maintenance

Once you have successfully completed the initial credentialing process, it's essential to stay up-to-date with the renewal and maintenance requirements to maintain your privileges and credibility.

  1. Stay informed: Regularly review the credentialing requirements and policies of your facility, as they may change over time. Make sure to stay aware of any updates or changes that may impact your status.

  2. Keep documentation current: Make it a habit to update your personal and professional information as changes occur. This includes maintaining up-to-date records of your medical license, DEA registration, board certifications, malpractice insurance, and continuing medical education (CME) credits. Having current documentation readily available will make the renewal process much smoother.

  3. Track expiration dates: Be mindful of the expiration dates for your various licenses, certifications, and registrations. Set reminders on your calendar or utilize a tracking system to ensure you renew all necessary documents in a timely manner to avoid any lapse in your credentials.

  4. Complete CME requirements: Stay current with your CME requirements as set forth by your specialty board and facility. Regularly participating in educational opportunities and maintaining accurate records of your CME credits will make it easier when it's time for renewal.

  5. Be prepared for periodic recredentialing: Depending on your facility and specialty, the recredentialing process may occur every two to three years. Stay prepared by keeping all your documentation up-to-date and organized, so you're ready to submit the necessary information when the time comes for recredentialing.

In Conclusion

Navigating the credentialing process can be a challenging yet essential aspect of maintaining a successful medical career. By staying organized, proactive, and informed, you can ensure a smoother and more efficient credentialing experience. Remember to seek assistance if needed and always prioritize the renewal and maintenance of your credentials to maintain your professional standing and provide the highest quality care to your patients. Ultimately, the time and effort invested in the credentialing process will pay off in the form of a secure and rewarding career in the healthcare field, allowing you to focus on what truly matters – providing exceptional care and making a difference in the lives of your patients.

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