Document Checklist For Provider Credentialing

Getting Confused about the Provider Credentialing Checklist Requirements? Want a ready-to-use, simple checklist? This article is for you.

Provider Credentialing is a necessary step for the smooth functioning of the Healthcare process. Whether it is a physician, a non-physician, or a group, they will need to be Credentialed to be able to bill any service to the insurance payor. Providers will also need to enroll in and become a part of the payor’s network so that they are eligible to offer services to patients who have subscribed to the payor’s insurance schemes.

Credentialing is a document-intensive process and typically takes between 3-6 months to complete. Missing documents or misinformation may add more weeks to the process. As such, a ready reckoner of documents required for Credentialing & Enrollment can come in handy.

Here are some handy checklists, prepared by specialists at Apaana Healthcare, that you would require as a physician, non-physician, or a group.

Provider Credentialing Checklist for Groups

Articles of incorporation of the group
Commercial liability insurance of the group (with NSC added as a certificate holder – for DME only)
IRS letter – CP575  
W-9 form giving the Tax-ID  
DL or Social Security card copy of the owner  
Social Security number (if only DL was given above) of the owner  
Hours of operation (Monday through Friday and Saturday/Sunday)  
Group start date of operations  
Owner’s medical degree certificate (if a Provider)  
Owner’s board certification (if a Provider)  
Owner’s DEA license (if a Provider)  
Bank letter with the branch contact person’s name and phone number OR a voided check  
NPPES registry screenshot providing the group NPI

The above checklist covers the document requirements for Credentialing of a Group. This would serve as a handy list to refer to, as and when you arrive at the stage of Credentialing. Keep it saved or bookmarked for easy fetching.  

Next up, we have a similar checklist for physicians/non-physicians.  

The above Credentialing Checklist covers the document requirements for Credentialing of a Group. This would serve as a handy list to refer to, as and when you arrive at the stage of Credentialing. Keep it saved or bookmarked for easy fetching.  

Next up, we have a similar checklist for physicians/non-physicians.  

Physician Credentialing Checklist

Copy of board certification(s) (if applicable), if board eligible, include a letter of eligibility  
Copy of current DEA certificate  
Copy of current State Medical License (Physician) or Nurse Practitioner License  
Copy of current CDS License or Advanced Nurse Practitioner License  
Copy of Social Security card  
Copy of ECFMG Certificate (if foreign medical graduate) or other equivalent certificates  
Copy of proof of US citizenship (if applicable)  
Copy of Fellowship Certificate (if applicable)  
Copy of Internship/Residency Certificate(s)   
Copy of Malpractice Insurance Certificate or signed Statement of Non-Coverage  
Copy of Medical Diploma and/or another pertinent diploma  
Copy of NPI Notification Letter  
Curriculum Vitae  
Occupational License  
Copy of Driver’s License  
Copy of Hospital Affiliation Letters

Note – This Physician Credentialing Checklist covers most of the documents that you need to keep handy and up-to-date for faster Credentialing.  

There could be some other documents depending on your specific practice or specialty. If you want to get practice specific Credentialing Checklist, email specialists at Apaana Healthcare for prompt and expert assistance.  

Additionally, you must note that,  

Credentialing Is Not A One-Time Process   

Credentialing is, in fact, carried out several times.  

Credentialing is initially carried out when a Provider starts/joins a practice.  
It is again required when a Provider moves groups or joins a new practice group.  
It is carried out every time they enroll with a new insurance payer and,  
It is carried out once again when they have to get re-Credentialed to maintain their Credentialing. Re-Credentialing is done every few years.

Yes, that’s a lot of Credentialing (read the paperwork!)  

Looking at passing on this mountain of paperwork to a reliable and expert partner?   

Apaana Healthcare is a professional physician Credentialing software service that will help you free up your time. Let Apaana take care of your Credentialing needs as you take care of your patients and make more money. With Apaana Healthcare’s efficient software backing you up, you won’t have to worry about,  

checklists such as these,  
the differences in Credentialing procedure over states,  
disruptions in work caused by the frequency of the process,  
the hassle of getting your hands on peer references or,  
taking time out of already taxing time schedules to deal with unending documentation

You will also sidestep issues caused by candidates providing incomplete information which leads to exhausting communication between the Credentialing body and the candidate. Such delays result in staff scheduling issues and eventually losses in your business.   

Let us allow you to work with a single-minded focus. At Apaana Healthcare, there are no distractions, only rigorously followed procedures. To understand how exactly we can assist, visit our website, or get in touch at [email protected]