FAQ

Key mistakes include submitting incomplete applications with missing signatures or documents, providing outdated or expired documentation, failing to disclose required information (gaps in employment, malpractice claims, disciplinary actions), not responding promptly to requests for additional information, and missing critical deadlines. Also, avoid using inconsistent information across different applications, neglecting to maintain current contact information with credentialing organizations, and failing to track renewal dates for licenses and certifications. Consider using credentialing services to help manage the complex requirements and timelines across multiple organizations.

Recredentialing is the periodic review and renewal of your credentials to ensure ongoing compliance with standards. Most organizations re-credential providers every 2-3 years, with hospitals typically following a 2-year cycle and insurance plans varying between 2-3 years. The recredentialing process involves updating your application with any changes to licenses, certifications, practice locations, or incidents, and may include peer review evaluations and quality metric assessments. It’s generally less intensive than initial credentialing but still requires attention to deadlines and documentation updates.

Essential documents include current medical license(s), DEA registration, board certifications, CV with complete work history, medical school diploma and transcripts, residency and fellowship certificates, malpractice insurance declarations page, hospital privileges documentation, and Medicare/Medicaid enrollment information. You’ll also need to provide references from colleagues, complete background check authorizations, and may need additional specialty-specific certifications. Keep digital copies organized and ensure all documents are current, expired items will delay the process.

Primary source credentialing usually takes 90-120 days, though it can extend to 180 days or longer depending on the complexity of your background and responsiveness of verification sources. Initial hospital credentialing often takes 120-180 days. Insurance payer credentialing varies widely, from 30-90 days for some plans to 120+ days for others. Factors that can delay the process include incomplete applications, delays from primary sources (medical schools, training programs, state boards), international education or training requiring additional verification, gaps in employment history, and high application volumes during certain times of year.

Medical credentialing is a process by which medical organizations verify the credentials of healthcare providers to ensure they have the required licenses, certification and skills to properly care for patients. It’s an essential function for hospitals and others which precedes hiring or obtaining coverage by an insurance carrier. Medical credentialing is perhaps most important because it’s the one method that permits patients to place their trust with utmost confidence in their chosen healthcare provider(s). Through a standardized process involving data collection, primary source verification and committee review by health insurance plans, hospitals and other healthcare agencies, patients are confident in their healthcare professional’s ability and experience.

Medical Credentialing is the process of contracting with Insurance companies in order to become an in-network or approved medical provider for that company. Becoming a participating provider for insurance companies in your area is an extremely important part of any medical practice. Whichever companies you are contracted with will dictate which patients you are allowed to treat and what your reimbursement rates will be.

Providers and hospitals have many questions in reference to on-board medical credentialing protocol(s). The following blog post, Credentialing (On-Board Process for Providers, Facilities)  discusses our overall protocol in detail.