12 things you’ll need for a smooth credentialing process

By | December 26, 2018

Physicians receive rigorous medical training for the better part of a decade. However, we emerge unprepared for the real-world job application process to which our friends in other professions are accustomed. One of these logistics includes credentialing and verification for hospitals and clinics where your group intends to practice — a process that can take up to three months.

There are a number of items that are requested during the credentialing process for solo and group practices as well as university-affiliated hospitals. I recommend that you keep the following documents, along with certification numbers, updated and stored together in a single email so that they can be expeditiously sent to committees to complete credentialing.

1. Driver’s license. A passport or other government-issued identification is an acceptable alternative if you do not have a driver’s license, but these are always requested by committees. A driver’s license typically needs to be renewed every five years around your birthday. A passport-sized professional photo is sometimes requested to present your application during routine meetings with other hospital staff members.

2. 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.

3. Medical license. An active medical license is required for every state in which you are practicing or intend to practice medicine. A list of previous or inactive medical licenses may also be requested. Most medical licenses need to be renewed every one to two years.

4. Board certification (or eligibility) status. This information is required by every credentialing committee. Most physicians who have recently finished their residency training are waiting to take one or more exams to complete their board certification. In this case, a letter from the residency program director with the program completion (i.e., graduation) date will suffice. The same policies apply to subspecialty or additional board certifications. Board certification typically requires renewal every 10 years.

5. Curriculum vitae (CV). The CV is requested by every credentialing committee and should be updated monthly. Pay attention to the first few pages of example and template CVs, including the demographic data, education and licensure, awards and honors, practice history and hospital affiliations, peer-reviewed publications or presentations, and any press.

6. Peer reference information. It is helpful to have the contact information of close colleagues in your specialty that you can refer to for thorough and timely recommendations, which are requested by every committee. This list can include training program directors, other clinical mentors, and colleagues with whom you have worked with in recent years.

7. Tuberculosis (TB) testing. A recent skin PPD test or Quantiferon Gold blood assay is always requested and is expected to be repeated every year for healthcare employees. Positive testing suggests exposure and is usually followed by a chest radiograph to rule out latent TB.

8. Immunizations. Information regarding Hepatitis B vaccination as well as MMR (measles, mumps, rubella) is required with the initial credentialing application. It is recommended to provide any further information about any boosters in a timely fashion. Similarly, annual documentation of your flu vaccine (or a waiver for the flu vaccine) is required.

9. Adult and Pediatric Advanced Cardiac Life Support (ACLS, PALS). Up-to-date certification with wallet cards is required by every credentialing committee. Many hospitals offer subsidized in-house ACLS courses to ensure all house staff officers and private physicians alike are well versed in resuscitation protocols. Online courses for ACLS and PALS refreshers are also available. ACLS and PALS require renewal every two years.

10. Malpractice insurer coverage. Most practices will request information about your current malpractice coverage, especially if it is not to be provided by your new practice. Insurers usually look at the frequency and severity of claims over the last five or ten years of practice. In addition, tail coverage may be required by the previous employer to cover any claims made well after a provider has left the group. Pertinent information includes certificate number, occurrence versus claims-made policy, maximum individual and aggregate limits, practice location, part- versus full-time status, dates of coverage, and any retroactive date of application.

11. Medical school and post-graduate training diplomas. The diploma, along with a letter from your medical school dean of student affairs, is occasionally requested by credentialing committees.

12. Privileges request form. Alongside any institution-specific application, most clinical practices representing procedure-heavy specialties will send a form that dictates the requested skill sets that require final approval from the hospital committee.

In addition to the above items, there are some additional documents about which you should inquire with your practice about submission alongside your application:

Case logs. Many credentialing committees will request details about your case and patient load, including number and types of cases. Some groups will request that you provide a case log for procedures completed in the past year. Newly graduated physicians should obtain a copy of their ACGME case logs and be ready to provide it to the credentialing committee for your first job. Individual physicians are strongly encouraged to keep a spreadsheet of their own cases.

Drug Enforcement Agency (DEA) license. Your DEA license is required if you are in a specialty and practice where you or another health care practitioner is administering or prescribing narcotic medications. The DEA license must be renewed every three years.

Standardized physician credentialing systems. Common applications are sometimes utilized by credentialing committees to serve as a single repository of information accessible to physicians, practice administrators, and health plans alike. Examples include California Participating Physician Application and the Council for Affordable Quality in Healthcare Universal Credentialing DataSource. These applications conglomerate information regarding your training, licensure, practice and malpractice history, and any prior or pending actions on your medical license or clinical practice limitations.

Educational Commission For Foreign Medical Graduates (ECFMG) certification. This documentation is only required for prospective residency and fellowship applications from outside the United States.

Aalap Shah is an anesthesiologist.

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