Credentialing involves communicating with agencies, boards, schools, and other organizations, to verify medical providers’ qualifications. This protects patients and prevents lawsuits. Contacting sources of verification and cross-checking every piece of information is imperative, and the responsibilities are ongoing even after provider onboarding.

Establishing state licenses and DEA numbers takes time, but with attention to detail and a significant amount of follow-up, new providers will be able to treat patients without delay. Waiting for approval can be costly.

Skillfully managing this important and necessary aspect of a healthcare business can significantly impact staff revenue production and more, including quality of patient service, employee satisfaction and morale, and even practice stability.

Optimizing Provider Credentialing Process

The optimum credentialing process is designed with efficiency and accuracy as central goals, so that providers can begin seeing patients in a new state, facility, or surgery center, as soon as possible. But “as soon as possible” can vary widely, depending on several factors – some of which are in your control.

Licensure processes and credentialing requirements vary by state and are subject to change, which adds to the complications and increases the potential for error. The best way to master the credentialing process is a diligent effort to be organized, on time, and up to date.

Avoid the Appeal of “Organic, Team Approach”

Clearly outlining the process saves time. Defined steps will aid to create consistency and improve accuracy, as well as help to keep all internal parties on schedule. If you already have a written outline, make a point to review it to see if it could use refining.

Designating one single “point person” will prevent confusion. With a modern system, all parties can be transparently accountable for deadlines and aware of upcoming renewals, while one person is solely responsible for cross-checking information and communicating with sources of verification.

Being Prepared and Organized

The below are the most commonly requested documents for credentialing and licensing. It is important to ensure they are properly formatted, file extensions are accurate, and stored in a systematic fashion, readily available for digital sharing via a secure system.

• Current CV (in correct month/year format)
• Diploma/degree
• Training certificates
• Internships and residency documents
• Affiliations and board certifications
• State medical license(s)
• Specialty certificates
• Continuing Medical Education (CME) credits
• Proof of insurance from previous facilities for the past 10 years
• Explanations for any malpractice or disciplinary sanctions
• Health records, current vaccinations documentation
• Several professional references with full, updated contact information
• Transcripts of Licensing Examination Scores
• 24-month procedure logs demonstrating work experience
• Proof of citizenship
• Color copies of passport and driver’s license

Assiduous Attention and Planning

Accuracy and timeliness make all the difference. Late applications and ones with errors can cause more than delay; some licensing boards will have fines or void the application altogether. Fill out the paperwork with great attention to detail, and anything that isn’t applicable mark it N/A instead of leaving blank. Provide clear explanations when appropriate, or else more details or clarification may be requested, taking more time.

Unanticipated delays can arise during credentialing and licensing processes, so give yourself more than the time you expect it will take. Note application deadlines on a calendar and set program reminders (if your system does not automatically,) watch emails closely for related communications, listen to voicemails daily, and respond right away. Responsivity will pay off.

Stay Current on Requirements

Make a sustained effort to keep informed about changes to credentialing and licensing requirements, and update your internal processes accordingly. Familiarity with requirements will help you be better prepared when the time comes to renew a license or certify a provider. Think of it as studying along the way instead of cramming for a test.

Audit Your Records Regularly

A routine systematic review of the status of new applications, as well as current providers’ renewal dates, qualifications, licenses, and privileges, will help to keep your practice legally protected, and approvals and reimbursements timely. Many practices hire a third party to perform annual audits to ensure the accuracy and thoroughness of license records.

Full-Service Credentialing and Licensing

Licensing and credentialing take time, attention to detail, follow-up, and follow-through. Our experienced credentialing team works tirelessly as your liaison, coordinating verifications with state medical boards and medical facilities, ensuring every required form, fee, and documentation is filed correctly and submitted on time. The results are faster approvals, diminished legal risks, a better bottom line, and more time for you and your staff to do what you do best.

If you are over the DIY approach or need help developing and implementing an effective system, ask Sullivan Management and Consulting Group about credentialing and licensing services.