Insurance Credentialing

Now that we are under way with our project, it is time to focus on requirements once the building is complete. Although at Practice Setup we suggest to each physician that the credentialing process be started at the very beginning of the project, it is now time to get serious about this process as it takes weeks if not months to go through the process.

Our team will begin to do the following to insure that the physician is ready when the time comes to open the doors for business.

• Gathering information about a doctor's background and qualifications through a formal application process
• Checking the background information for completeness and accuracy:

1. Checking the information against reliable sources, including the National Practitioner Data Bank and the American Board of Medical Specialties

2. Contacting:
• Any state where the doctor has a medical license, to be sure there are no limitations on practicing medicine in that state
• Schools and hospital programs, to be sure the doctor's training is complete and accepted by the specialty board
• The National Technical Information Service, Drug Enforcement Agency or Controlled Drug Substance Registration, to confirm that the doctor is authorized to write prescriptions
• Medicare/Medicaid, to make sure that the doctor is not banned from caring for Medicare/Medicaid patients

3. Reviewing the doctor's:
• Personal conduct history, to determine if any disciplinary actions have been taken
• Malpractice insurance, to confirm active coverage

• Malpractice claims history
• Hospital privileges history, to determine if privileges have been lost or limited
• Work history and employment background