Credentialing Corner

# The Ultimate Checklist for Provider Credentialing Success

- July 3, 2023
- Posted by Kristen Edwards

03 Jul

Provider credentialing is crucial to ensure the healthcare specialist meets the required qualifications and standards to provide quality care. Provider credentialing involves specific steps, including a complete provider credentialing checklist, which contains verification of the provider’s education, training experience, issued license, and other credentials to verify their credibility and competence. Maintaining high-quality standards and meeting regulatory requirements, successful provider credentialing is a vital step for healthcare organizations.

This blog represents the ultimate checklist for provider credentialing success to facilitate the efficiency of this complex process. Now healthcare organizations can guarantee a smooth and efficient credentialing process by following this complete checklist while upholding adherence to industry standards.

## Importance of Provider Credentialing for Healthcare Organizations

In this era, patient safety and quality of healthcare are crucial. A checklist for provider credentialing plays a vital role in ensuring patients’ safety. By verifying the educational background, training, and experience of providers; organizations can build confidence in patients, payers, and regulatory bodies alike. Moreover, effective provider credentialing can contribute to healthcare organizations’ overall performance and credibility, hiring top talent and nurturing trust within the community.

Healthcare organizations can streamline their process with the comprehensive provider checklist for credentialing success and the endurance of compliance with industry standards. By adhering to these guidelines, organizations can fulfill regulatory requirements and create a robust network of qualified, competent healthcare professionals who devote their lives to delivering exceptional patient care.

## Streamlining the Provider Credentialing Process with the Checklist

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By implementing the ultimate checklist as their foundation, healthcare organizations can effectively overcome the complexities of provider credentialing, from initial document gathering and verification to ongoing monitoring and compliance. The provided checklist empowers organizations to make informed decisions, reduce risks, and sustain a high standard of care. In the next portion of the blog, we will learn each checklist component in detail, provide valuable insights and implement practices to ensure a smooth transition of the provider credentialing process.

## Provider Credentialing Checklist for Medical Providers

### 1) Collection of Required Documentation

Initiate the credentialing process through the collection of necessary documents. This step commonly involves educational documents, board certifications, current licenses, training certifications, professional liability insurance, and a detailed resume. All the records should be up-to-date and accurate.

### 2) Verification of Educational Background

Verify the provider’s educational background thoroughly. Recheck the confirmation of medical school certification, internships, residencies, and fellowships. This step may involve direct contact with educational institutions and licensing bodies to verify the degrees and certificates stated by the provider.

### 3) Validation of Licensure

This step involves the verification of the provider’s licensure in all the states where they intend to engage in the practice. Verify the licenses directly from the state medical boards to ensure they are active and don’t have any disciplinary actions or other restrictions.

### 4) Confirmation of Board Certifications

Contact the relevant specialty boards to check the validity of the provider’s board certificates. Make sure that the credentials are recognized by reputable organizations such as the American Board of Medical Specialists (ABMS) or the American Osteopathic Association (AOA). Ensure that these certifications are current as well.

### 5) Overview Work History

Review the provider’s history, including his employment, designation, and affiliations. Check the confirmation dates and responsibilities with reference checking and consulting with the HR department of the previous employment office.

### 6) Perform Peer References

Meet the professional references given by the provider. Investigate with previous office collogues, supervisors, and company owners to collect insights into the provider’s clinical skills, professional attitude, and overall work performance.

### 7) Access Malpractice History

Collect National Practitioner Data Bank (NPDB) report to review the provider’s malpractice claims. This report will provide a detailed history of malpractice settlements or judgments against the provider. This report will help you in accessing the provider’s liability risk.

### 8) Evaluate Clinical Competence

Examine the provider’s clinical competence by conducting peer reviews, surveys on patient satisfaction, and evaluations of clinical performances. After this step, you can ensure that the provider meets or exceeds the expected quality standards.

### 9) Confirm Insurance Coverage

Make sure that the providers have sufficient professional liability insurance coverage. Confirm the policy limits and expiration dates. Ensure that they will comply with the organization’s requirements.

### 10) Verify Sanctions and Exclusions

Verify that the provider is not subjected to sanctions or exclusions from engaging in federal healthcare programs by searching federal and state databases, such as the Office of Inspector General (OIG) and the System for Award Management (SAM).

### 11) Review of Compliance with Regulatory Bodies

Ensure the conformity of providers to relevant regulations, guidelines, and quality standards. Ensure he complies with multiple regulatory bodies, such as the Centers for Medicare and Medicaid Services (CMS) and the Joint Commission.

### 12) Establishment of Health Plan Contracts

Initiate the contracting process if the provider works with health insurance plans. Apply accordingly and verify the required necessary certifications required by each insurance provider.

### 13) Maintain Ongoing Monitoring

The success of a provider credentialing checklist is not a one-time event; it requires ongoing checks. Try to implement a system that regularly reviews and updates provider credentials, including license renewals, certifications, and insurance coverage.

### 14) Use of Credentialing Software

You can streamline and automate the credentialing process by implementing credentialing software. This software will help to manage and track all the necessary documentation, deadlines and update more efficiently.

### 15) Keep Industry Changes Updated

Keep updating the credentials with the latest advancements and developments in provider credentialing requirements, regulations, and best practices. Subscribe to relevant YouTube channels and newsletters, attend the latest industry conferences, and participate in webinars to ensure compliance and optimization of the credentialing process.

### Conclusion

Checklist for Provider Credentialing is a vital process for healthcare organizations to ensure patients’ safety and maintain high-quality standards. This blog represents a checklist for provider credentialing success. Organizations can streamline the credential process by following the ultimate checks for provider credentialing success mentioned above. Moreover, organizations can reduce administrative loads and ensure compliance with regulatory requirements. Following an efficient credentialing process not only ensures patients’ safety but also enhances the reputation of healthcare organizations in the progressive healthcare landscape. The provider credentialing process is an ongoing procedure that requires regular monitoring and updating to maintain compliance and ensure the highest quality of healthcare delivery. By following up on the checklist for provider credentialing success and staying updated about industry changes, healthcare organizations can achieve optimal provider credentialing success.

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