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9 things a doctor needs to know about credentialing and the process

1. Primary source verification.

The purpose for credentialing is to confirm qualifications and professional identity. Providers hoping to accept locum tenens jobs begin by filling out an online application, which is then verified by internal credentialing representatives.
The credentialing team contacts employers and hospitals where providers hold privileges to make sure they are in good standing.

2. Gathering Documentation

For credentialing, be prepared to provide:

  • Medical licenses
  • DEA certification
  • Board certifications
  • Medical school diploma
  • Proof of training, including residency and fellowship
  • Official change-of-name documentation if applicable
  • Life support certifications, such as advanced cardiac life support (ACLS)
  • Scan, email, fax, or mail pictures of these documents to the credentialing team; hard copies aren’t usually needed

3. Foreign Status

Physicians trained internationally are required to submit their Educational Commission for Foreign Medical Graduates (ECFMG) certification as well as proof of permanent resident status or H-1B visa.

4. Professional References

Each provider is required to identify at least three references, two of which should be from clinicians within their specialty. Providers should also list their program director as a reference. Be sure to verify correct contact information for references. It slows down the process when a reference can’t be reached and/or a new name needs to be submitted.
References should provide a view of competency over the past two years, especially in procedures expected while on assignment.

5. External Credentialing

Once provider data is confirmed, agency credentialing is finalized and remains valid for two years. However, providers will need separate credentialing for each assignment at each new facility. This is referred to as external credentialing, and it’s required because each facility has its own requisites and insists on its own primary source verifications.
The good news is the external credentialing team pre-populates the hospital application with the information the internal credentialing team compiled to save time.
After the internal team fills out as much of the information as it can, the provider is contacted to complete all outstanding fields. It is then forwarded to the hospital. From there, the external credentialing team works directly with the facility to fill in any blanks or answer questions. The team’s ultimate goal is to save doctors time so they can treat patients rather than fill out paperwork.

6. Medical Tests

Hospitals mandate clinicians have current vaccinations for:

  • Hepatitis B
  • Measles, mumps and rubella
  • Varicella
  • Tetanus, diphtheria and pertussis
  • Meningococcal disease
  • A negative tuberculosis test result within the past year is also required

7. Medical Specialties

At Weatherby Healthcare, credentialing teams are divided into medical specialties. This helps streamline the process because members are familiar with the specific terminology and procedures.

8. Full Disclosure

Report all licensure sanctions or malpractice claims in detail. Also, make sure applications match the CV because all discrepancies must be investigated, even two-month differences. The process becomes much easier when accurate information is provided.

9. Clear Communication

Finally, timely communication with consultants and credentialing representatives can help prevent delays. Providers should expect to let credentialing teams know their preferred method of contact for expedited resolutions.