Physician Credentialing Checklist

April 7, 2021

For any physician looking to expand their client base, physician credentialing is a crucial business step. Credentialing enables you to work within insurer networks. Billing in-network simplifies the revenue cycle and opens you up to more potential patients.

It’s a standardized industry practice – but that doesn’t mean that the process is simple – It’s time-intensive, meticulously detailed, and each insurer’s requirements are slightly different. One error in an application can delay the credentialing process weeks or even months.

This checklist will help you visualize and track the main steps in the physician credentialing process.

Physician Credentialing Checklist Steps

Research

Determine which insurer networks are viable for your practice – and which fee schedules appeal to you.

  • Research private + public insurers
    Nationwide insurers will be the easiest to identify and vet for your credentialing.
    • Medicare
    • Medicaid
    • Commercial insurance
  • Research local insurers
    Smaller, regional insurance networks often have sizable client populations. There are a few ways you might find all available options:
    • Ask local colleagues
    • Consult ACA exchange websites

Determine a workflow

This process is time-sensitive and has a lot of moving parts. Figuring the order of events and methods ahead of time will ensure success.

  • Scheduling
    The process can take anywhere from 60 days to 6 months. Anticipate the schedule so you can hit the ground running as soon as the credential is approved.
    • What is the turnaround time for each application?
    • When will you submit the application?
    • When will you follow up with the companies?
  • Materials
    Each application is unique, and insurers often update the protocol for their applications. Find the most current information for the following fields.
    • Documents
    • Contact information
    • Relevant notes about the process
  • Delegation
    Someone will need to file and track this application. Who will it be? Here are ways to figure out the best fit
    • Determine the cost – in labor hours – of managing the application yourself.
    • Determine the cost – in labor hours – of assigning the task to an admin person.
    • Research third-party service
      • Ask colleagues for recommendation
      • Assess criteria
        • Cost
        • Success rates
        • Customer reviews

Assemble documents

Every application is different, and each should be given equal care. Some important documents will likely be required for each application. Prepare to organize the following documents.

  • Medical practice documentation
    • IRS forms (eg. W-9, CP575)
    • Business license
    • Copy of lease
    • Bank account verification
  • Physician documentation
    • Education
    • Certification
    • Licenses
    • Work history
    • Clinical privilege history
    • Peer references
    • Insurance claims history

Submit application

This step goes beyond simply pressing the ‘Submit’ button. A single error in your application can delay it for months – and a delay in credentialing is a delay in reimbursements.

  • Verify requirements for each application
    Double-check the list of necessary documents. Make sure you’ve supplied each one according to specifications.
  • Double-check for errors
    Make sure you’ve done so according to each application’s requirements.
  • Submit
    When you’re confident your application is error free, finalize the submission.

Track progress

It’s important to be proactive in the time after you submit the application. If there is a complication with the application, you’ll want to know as soon as possible. The best way to ensure that is to check in regularly with each insurer.

  • Document contact info for each application liaison
    Locate the applicant liaison at each insurer.
  • Create follow-up timeline
    Schedule update communications to go out for each insurer. We recommend contacting them once every 3 weeks.
  • Reach out
    Contact each insurer according to your schedule. 

Physician Credentialing Services With Quatris Healthco

If you’re starting a new practice and looking for a partner to help you meet your credentialing needs and beyond, we’re experts in getting practices set up for success across the board. Our physician credentialing service helps medical practices across the country minimize mistakes and maximize their collections.

Learn more about the credentialing services we offer, or reach out to us today to find out how we can help.