Medical credentialing is the process used to ensure that healthcare workers can safely deliver high-quality patient care. It typically requires gathering, verifying, and investigating extensive amounts of information for each provider. A provider credentialing checklist is a helpful tool for guiding the process and preventing the costly delays that missing documentation can cause.
The following facility credentialing checklist offers a helpful snapshot of the items typically gathered. It can be tailored to fit the specific process your facility uses for each provider type. Adhering to a list is a great way to get organized, identify challenges, and track your progress. Simplify the process even more with this provider credentialing checklist template.
Why Is Healthcare Credentialing Important?
Credentialing does more than prevent unsafe providers from accessing patients — which is crucial in its own right. For some types of providers, the process also enables facilities to bill for services rendered, and greatly reduces liability risk.
All Practitioners That Provide Patient Care Must Be Credentialed
At its foundation, the credentialing process is intended to safeguard patients against those who lack the education, training, and clinical competency to provide care within their scope of practice. This means that the process applies to any professional who engages with patients, at any level. However, standards are the most rigorous for those who have a great deal of independence in their practice.
Credentialing Checklists for Providers May Vary
The stringency of the credentialing process varies by provider type, organization, state law, and the scope of responsibilities agreed upon with payers. For example, credentialing a certified nursing assistant (CNA) is far less involved than credentialing a physician. As another example, the credentialing process in California may involve navigating Medi-Cal-specific requirements. This means that credentialing checklists for providers aren't one-size-fits-all; they must be tailored.
Provider Credentialing Checklist for Healthcare Facilities
Starting with a baseline provider credentialing checklist, template, or spreadsheet is a great way to visualize the documentation needed. It can also help you streamline your efforts and avoid common pitfalls that cause delays, like missing information. The following checklist offers a helpful snapshot of the items typically gathered.
Personal Identity Information
Clinicians will need to provide information about who they are, how to reach them, and where they live. This is the groundwork for verifying the provider's identity, and it also helps to facilitate billing processes when they begin. Some clinicians keep this information in a central database, such as CAQH ProView, to avoid repetitive submissions.
Tips: The credentialing process may require the electronic transfer of sensitive information such as Social Security numbers. Use secure file transfer practices to safeguard digital files.
Checklist items:
- Name
- Social Security number
- Email address
- Street address
- Government-issued ID with a photograph, such as a driver's license or passport
- A recent photograph (signed, dated, or notarized)
Professional History and References
Request a comprehensive curriculum vitae (CV) that maps out the clinician's education and work history. It should be in chronological order and include a month and year for each event on the timeline. Any lapse of 30 days or more should be accompanied by a written explanation. This should be accompanied by at least three professional references that verify competence and ethical practices.
Tips: Significant gaps in a timeline should be thoroughly investigated because they can indicate license suspension, substance abuse, legal problems, or other issues that could impact the ability to provide safe patient care. Cross-check each clinician-provided explanation against primary sources.
Checklist items:
- Provider CV
- Written explanation for every time gap since medical training began
- Reference letters from colleagues or supervisors, with contact information
History of Privileges Granted
A clinician privilege history is a collection of documents that maps out all facilities where privileges were held, when they were held, and the scope of each. This documentation should include disclosure of any privileges that were reduced, suspended, revoked, surrendered, or denied, and an explanation for each event.
Tips: It's important to note that accepting the clinician's account of their privileges isn't sufficient. Facilities performing credentialing are legally required to check primary sources, such as the National Practitioner Data Bank, for actions taken against clinical privileges.
Checklist items:
- Clinician privilege history
- Written explanation for any actions taken against clinical privileges
Training and Education Documentation
Each clinician must provide proof that they've completed the education and training required for their profession. The exact transcripts, diplomas, and certificates collected and verified will depend on the provider's role.
Tips: Some healthcare roles require specialized clinical training. For example, imaging technicians are often required to hold current American Registry of Radiologic Technologists (AART) certification. Create a provider onboarding and credentialing checklist for each role to streamline the information-gathering process.
Checklist items:
- Undergraduate diploma
- Medical school diploma
- Certificate of completion of an internship, residency, or fellowship
- Proof of any continuing medical education (CME) or continuing education (CE) credits earned
- Proof of completion of a life-saving certification course within the past two years (such as BLS, ACLS, or PALS certificates)
Licensure Documentation and Professional Certifications
Providers applying for a role that requires licensure will need to present a valid, current, unencumbered license for their professional area. These items will vary in accordance with the role. For example, a nurse practitioner credentialing checklist will include verification of registered nurse licensure as well as national certification from an accredited body.
Tips: Not all physicians are board-certified. If a doctor claims this, it must be verified with the issuing authority.
Checklist items:
- Active medical license
- Board certifications
Identification Numbers
Collect the identifiers that have been issued to the provider by regulatory agencies. This will allow you to query the agency's database to confirm that the credentials have not been falsified. We've listed common identifying numbers for a physician credentialing checklist below.
Tips: Transcribing numbers from one source to another (for example, from a photocopied license to a spreadsheet) introduces a risk for error. Using automated credentialing workflows may cut down on errors.
Checklist items:
- Medicaid number
- Medicare number (also called a Provider Transaction Access Number, or PTAN)
- National Provider Identifier (NPI)
- Drug Enforcement Agency (DEA) license number
- Controlled dangerous substances (CDS) certification (only required in some states, and it may go by a different title, such as controlled substance registration)
Health History
While it's not necessary for practitioners to share their entire history, facilities must know that the provider is fit to provide care. This often includes verification of current immunizations. The provider may also have to answer a series of questions that relate to physical and mental fitness for duty.
Tips: Avoid stigmatizing questions about past health issues, whether mental or physical. Focus on current fitness for duty through the use of industry-standard health status questions.
Checklist items:
- Immunization history
- Tuberculosis (TB) test results
- Answers to confidential health questions
Get More Healthcare Leadership Resources
Creating tailored provider credentialing checklists for your team will give you a headstart when it's time to dig into the documentation. Want more support? Take advantage of our healthcare facility templates and guides to continue optimizing and fine-tuning your workflows.