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What is needed for a complete credentialing file?

Throughout your career as a healthcare provider you will need easy access to history of your education, training, certifications, licenses, and details about your professional performance since completing your medical education.  Whether for hospital privileging, medical licensing, employment, or insurance credentialing purposes you need to maintain more than a summary CV of your past.  It is important that you track every significant event since finishing your medical education.

Here are some of the important elements and documents to maintain in your credentialing file:

  • Complete and current CV
  • Medical education diploma
  • ECFMG certificate
  • Board certificate(s)
  • Training certificates (internship, residency, fellowship, etc)
  • State License(s)
  • DEA certificate
  • Certificate of Insurance (“COI”) for your current malpractice coverage
  • Work gap explanation for any work gap greater than 6 months
  • Details of any sanctions
  • Details of any malpractice cases
  • Explanation of any criminal convictions
  1. CP-575 from the IRS when you obtain your tax id
  2. W-9
  3. Business license (if applicable)
  4. Letter from your bank verifying your business bank account
  • A complete and current CV in chronological order that tracks all professional experience and education since graduating medical school.  The CV should have mm/yyyy format for all your start and end dates, and also include any work gaps with detailed explanation for the gap.
  • Clean legible copy of your medical education diploma.  Take a digital picture of your diploma before framing it, or after framing if you are catching up your credentialing file.  For the most part, you will need official transcripts to verify completion of education, however, there are times when a simple copy of your diploma is requested (and required), so be prepared.
  • Clean legible copy of your board certification(s) completion certificates.  Although primary source verification is typically done of board certification, there are many situations where an insurance carriers requests a current copy of your certificate.  Make sure to always have copies when you renew a certificate.
  • Copy of completion certificates for all medical training (internship, residency, fellowship, etc). Maintain details of facility address, program director, and mm/yyyy of start and end of training.
  • Copy of your state license, DEA certification, and other special certifications that you have obtained (update your file as these renew)
  • Copy of a “Certificate of Insurance” (“COI”) for your current malpractice insurance.  This is essential in many situations and you should always have access to your current policy information.
  • Details of all malpractice cases in which you have been involved.  Whether a defendant or co-defendant, keep all details of every malpractice case in which you are involved.  Retain date of incident, status of the case, date closed or settled, settlement amount, % of liability, amount paid, and details of the case.  Although you normally need to produce the last 10 years of these types of details, it is important that you retain these details throughout your career.  This is often overlooked or neglected only to cause a problem or slow down a credentialing process when you least expect it.  Remember that all cases are reported to the National Practitioner Data Bank and you do not want a hospital or insurance company to halt your application because you signed off on an application as complete and attested to no malpractice cases only for them to find a case history when querying the NPDB.
  • Details of all sanctions whether from a healthcare facility, licensing board, professional organization, employer, or any other organization.  Maintain details of the incident, dates of occurrence, and outcome.  Stick to maintaining the facts of each incident.
  • Criminal records.  Be prepared to disclose all criminal convictions in your past.  You may rarely need some details, but be prepared to honestly present details of any convictions in your past.  Any matters related to your practice of medicine will require detailed disclosure and may cause rejections in many cases.
  • ECFMG certificate.  This is obviously an important document to maintain.  You will need a clean legible copy of this document throughout your career.

 

Every healthcare provider should take care to accurately maintain a professional file with full details throughout their career.  Maintaining your credentialing information and documents in one central location will help you to speed along the credentialing process with hospitals, health plans, and employers.  With today’s technology it is easy to maintain such information in a cloud storage space so that it is readily accessible from any location making the credentialing process even easier.