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For Physicians – Navigating the Credentialing Process

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Once you have signed an employment, partnership, or practice agreement, you should be prepared to begin work on the process of becoming credentialed. This process will results in your receiving medical staff privileges at hospitals, and nursing homes, office privileges for those who will be providing care through a Joint Commission accredited organization, and insurance credentialing for the many carrier with whom you will need to be enrolled.

Primary Source Verification

Once very important concept you need to understand is primary source verification. Basically this refers to the requirement that any and all health care entities must have documented proof that your educations, training , licenses, certifications, and other credentials are in facet verified by the primary source from which you received them. For each medical school, internship, residency, and/or fellowship you have been enrolled or involved in, you will be required to provide contacts information so that they hospital credentialing office can be in direct communication with that entity. Typically these are fax requests from the healthcare entity to the school or program. By providing specific fax numbers, including the names of the individuals who will be receiving the fax request, you will be facilitating the process.

Federal Credentials Verification Service

The Federal Credentials Verification Service (FCVS) was created in 1996 as a centralized repository for state medical boards to obtain a verified, primary source record of a physician's core medical credentials. When an applicant enrolls for their service, FCVS begins the process of collecting and maintaining the applicant’s primary source verification portfolio. Most State Board/ Osteopathic Boards do accept or request FCVS as part of licensure process, but not all. FCVS application and processing fees vary per applicant, depending on the level of information required. Rules regarding FCVS requirements and acceptance do vary from state to state and organization to organization. You should check early with the licensing body and credentialing entity where you plan to practice in to determine specific requirements before you enroll.

References

Primary sources verification is also required for your references. Although each health care facility may have individual requirements, you can expect that you will need to provide names and contact information for references and competency statements. Although you may already have written references letters from your program directors, chiefs, attendings,etc; these reference may be asked to answer very specific questions related to your clinical skills and patient care abilities. Again, this is often done by fax, so the more specific the contact information you provide, the easier it will be to complete the process. Be proactive in your approach.

In addition to verification sources, you should be prepared to provide the following documents directly to the credentialing office:

  • Current CV
  • Internship/Residency/Fellowship Certificates
  • ECFMG Certificate (If applicable)
  • All Medical Licenses ever held
  • Federal DEA Certification
  • Driver’s license or other photo ID
  • Permanent Resident Card (if applicable)
  • Social Security Card
  • Any Malpractice Claims with detail
  • Current Malpractice Insurance Information
  • Board Certifications
  • National Provider Identification (NPI)/ Unique Provider Identification Number (UPIN)
  • Residency procedure log
  • Written explanation of any gaps greater than one month on your CV
  • Documentation of CME

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