Medical credentialing is an important process for both physicians and hospitals. Physicians need to ensure that their credentials are up-to-date and meet the hospital's requirements, while hospitals need to verify the qualifications of potential employees. The process of credentialing can be complex, so we've put together this physician credentialing checklist to help you stay on track.
Whether you're a physician looking for a new job or a hospital manager tasked with hiring new staff, make sure you keep these items in mind.
What is Physician Credentialing and What Is It For?
Physician credentialing is the process of verifying a physician's qualifications, including their education, training, experience, and licenses. This process helps ensure that physicians are competent and safe to practice medicine. Hospitals use physician credentialing to verify that a physician is qualified to work at their facility and that they meet the standards set by the hospital.
Credentialing is not mandatory for all physicians, but it is required by most hospitals. If you're a physician who wants to work at a hospital, you'll need to go through the credentialing process.
Healthcare Provider Credentialing: The Process
The physician credentialing process can be divided into three parts: pre-credentialing, primary source verification, and re-credentialing. Let's discuss each one below:
Pre-credentialing is the first step in the physician credentialing process. During pre-credentialing, hospitals gather information about potential employees from their applications and other sources. This information is used to determine whether the physician meets the hospital's qualifications for the position.
Primary Source Verification
After pre-credentialing, hospitals must verify the physician's information through primary sources. This step includes verifying the physician's education, training, experience, and licenses. Hospitals may also require that physicians take a credentialing exam or complete a hospital orientation program.
Physicians must go through re-credentialing every few years to maintain their privileges at a hospital. Re-credentialing helps ensure that physicians remain competent and up-to-date on medical advancements and technologies. During re-credentialing, hospitals review the physician's credentials and may require the physician to undergo training or exams as needed.
Key Elements in the Credentialing Process
There are a few key elements that are important to keep in mind during the physician credentialing process:
- Applications: Hospitals will use physician applications to gather information about potential employees. Make sure you complete your application thoroughly and accurately.
- Primary sources: Hospitals must verify your credentials through primary sources, such as your medical school or residency program. Make sure you have the contact information for your primary sources readily available and that they are aware that they might be contacted to verify your status.
- Exams and orientation: You may be required to take a credentialing exam or complete a hospital orientation program. The exams and orientation help ensure that you are the right fit for the role you are applying for and are familiar with the hospital's policies.
- Re-credentialing: You will need to go through re-credentialing every few years to maintain your privileges at a hospital. During re-credentialing, hospitals will review your current details and may require you to take additional training or exams.
Steps To Take Before, During, and After Credentialing
There are a few steps you should consider before, during, and after the physician credentialing process:
- Gather all of the necessary documentation, such as your medical school transcripts and residency certificates.
- Complete your application and make sure all details are accurate.
- Familiarize yourself with the hospital's credentialing process and requirements.
- Choose a primary source verification (PSV) company if you will be using one.
- Follow the instructions from your hospital or PSV company.
- Respond to requests for information in a timely manner.
- Cooperate with any on-site visits or audits.
- Be prepared for exams and orientation programs.
- Keep track of your credentialing status and deadlines.
- Check that your credentials are accurate and up-to-date.
- Maintain your privileges by completing re-credentialing every few years.
- Stay current on medical advancements and changes in the healthcare industry.
- Keep your documentation in an organized and accessible place.
Types of Physician Credentials
There are a few different types of physician credentials that you may need:
- Medical degree: You will need to provide your medical school transcripts and proof of graduation.
- Residency certificate: If you completed a residency program, you must provide your residency certificate.
- Board certification: You may be asked to provide proof of board certification from a specialty board.
- State license: You need to have a state license to practice medicine. Requirements vary by state.
- DEA license: You need a Drug Enforcement Administration (DEA) license to prescribe controlled substances.
- NPI number: Your National Provider Identification (NPI) number is used to identify you in the healthcare system.
- Hospital affiliation: You may need to provide proof of your current hospital affiliations.
This is by no means an exhaustive list, and it can be longer or shorter depending on the requirements set by the hospital's administration. As some institutions may have more stringent guidelines and a longer provider credentialing checklist, it is best to be prepared and have a record of all certifications and achievements throughout your student and professional life on hand.
Physician Credentialing Checklist: Essential Documents To Prepare
To further simplify the experience and make sure you don't miss an important step during your job search, here are the things you will need to prepare for in the physician credentialing process:
- Application form
- Proof of graduation and medical degree
- Residency certificate
- Board certification
- State license
- CV or resume
- Personal statement
- Letters of recommendation
- On-site visit
- Credentialing exam
The physician credentialing process can seem tedious and intimidating, but if you take the time to prepare and gather all of the necessary documentation, you will be well on your way to a successful career in medicine.
On Time Talent Solutions Can Help With Your Job Search
On Time Talent connects healthcare professionals with top hospitals and facilities for a wide range of roles. We make the job search process easy so you can focus on what's important — your career.
If you're interested in finding a position in one of the top hospitals and healthcare organizations, browse the open roles on our list or contact us today. We can help you navigate the physician credentialing process so your journey toward your new career is as seamless as possible.
Our team of expert recruiters specializing in physician and health professional placements will work with you to find a role that meets your individual needs and preferences.