Medical credentialing is a meticulous review process of a health provider’s qualifications, including career history, education, training, residency and licenses, and any specialty certificates. Credentialing is done right before or when a provider is hired and it is critical that the information stays up to date.

To make sure a physician’s or nurse’s credentials are always current, medical credentialing, or healthcare credentialing, is repeated multiple times throughout a career and must follow and match all standards and rules established by the National Committee for Quality Assurance (NCQA) and The Joint Commission (TJC). Unfortunately for hospitals and other healthcare organizations, medical credentialing is labor intensive, time-consuming, tedious, and costly. As staffs are frequently overworked and don’t have the resources to devote to medical credentialing, it’s helpful to have an agency like Med Advantage to handle this laborious task.

To ensure accurate credentialing, here are the necessary medical credentialing criteria to evaluate before hiring a physician:

Proof of Identity
  • Government-issued photo identification
  • NPI number
  • I-9 documentation listed as List A or List B or List C as defined on form
  • VISA or Employment Verification card
 Education and Training
  • Proof of course completion and completion dates from a domestic or foreign medical school, internship, residency, fellowship enrollment and clinical degrees, and any other relevant experiences in MM/YY format.
  • Explanation of any time gaps
  • Fifth Pathway certification if applicable
  • ECFMG validation
Military Service
  • DD214 if recently discharged; complete list of military experience, including military branch and enlistment dates, if currently enrolled.
Professional Licensure
  • Complete list and/or copies of all professional licensure. Must include: issuing state, license type, license number, status, and issue and expiration dates.
DEA Registration and State DPS and CDS Certifications
  • Full list and/or copies of DEA, DPS, and/or CDS certificates. Includes issuing state, status, registration number, and issue and expiration dates
Board Certification
  • -Full list of Board-specialty certifications held including original, recertification, and expiration dates.
Affiliation and Work History
  • Chronological, comprehensive list of all facilities in which the provider has worked or had clinical privileges (academic appointments, hospitals, practice groups, surgery centers, etc.). Must include start date, date on staff, employment or staff status, verification or good standing, and end date.
  • Explanation of any time gaps
Criminal Background Disclosure
  • Federal state, and county databases
Sanctions Disclosure
  • Federal and state, if applicable
Health Status
  • Whether or not there is any record of physical or mental illness that could affect work
  • Healthcare-specific information on state/federal criminal convictions or civil judgments
  • Malpractice history and hospital sanctions
Malpractice Insurance
  • Comprehensive list of insurance carriers. This includes coverage dates and types.
  • List of open, pending settled, closed, and dismissed cases
  • Current certificate of insurance
Professional References
  • Professional references noting current competence

The good news is, Med Advantage only needs a medical practitioner’s application once. Our proprietary database stores, verifies, and formats the submitted medical credentialing information and afterward, all original and digital documents are sent to the healthcare organization. The final verifications report is automatically archived. Finally, a new medical credentialing date is set; you never have to worry if your providers’ credentials are outdated. The whole process requires minimal administrative effort, saving you time, money, and resources.

Contact us now and let’s discuss how we can help you with medical credentialing.