Medical Credentialing – How To Prepare and Succeed?


Medical education comes with multiple challenges. The tiring process of securing admission and clearing the board exams is just the tip of the iceberg. The true professional journey begins after the convocation ceremony ends. The medical professional must secure and renew the medical license. And more importantly, get the medical credentialing.

What is Medical Credentialing?

Physician credentialing or medical credentialing are the credentials awarded to healthcare professionals as a means to standardize the level of education and ability to provide patient care. Each medical professional must acquire medical credentialing; failure to do so is not possible for him/her to treat patients or render professional medical care.

How to Prepare for Physician Credentialing?

Medical credentialing is a long multi-step process that can take as long as 6 months. This process and the documentation involved are variable from state to state. It is highly advisable to have professional guidance for physician credentialing services to avoid delays, rejection, queries, and unexpected expenditures. Certain key aspects need to be focussed on to ensure fast physician credentialing.

Start early

It is always good practice to be prepared and start early. You should be sure about the states where you want to apply and be thorough with their rules and laws regarding medical credentialing. It is also helpful to plan whether you are planning to join a hospital setting, practice independently or acquire an established medical practice. The physician credentialing process will vary as per these options. When you have started early, you always have a buffer period to accommodate delays or rejections. 

Update your CV

You should prepare a professional resume with a crisp description of all your medical degrees, work experiences, previous postings, locum tenens hiring, hospital affiliations, previous medical projects are undertaken, and your overall patient handling experience summary. Be honest in your CV. If there is any past medical negligence or related lawsuit or any legal mention, it should be mentioned in the CV. 

Peer references

It is a standard rule to mention a couple of peer references in your CV as well as your physician credentialing application. Your references should not just be your colleagues from work, but your fellow professionals who know you professionally as well as personally. There is a strong chance that they will be interviewed by the agencies confirming your credentials; hence, it is important that they are aware of your professional career and achievements and they provide a positive review regarding your work and medical education. It is customary to provide the name of professors or heads of departments as your peer references. You need to include their name, contact number, email, and current job title.

Procedure logs

You need to have detailed documented proof of the work that you are claiming to have done. So, you need to request for all procedure logs from your current and previous workplaces to be submitted for physician credentialing. Your work history will be checked for at least the past 2 years. It is a good practice to maintain all logs for future references starting from the first day of your work till the current date.

DEA and NPI number

You need to apply for DEA (drug enforcement agency) number for all the states in which you wish to work. Likewise, every physician has a unique ten-digit personal identification which identifies him/her as a national provider identifier number (NPI). This NPI number must be updated after receiving a professional license and after any change in the level of education.

Paperwork and Deadlines

The physician credentialing services involve many support documents which expire over time. It is essential to note the deadlines of this expiry while physician credentialing is underway. Expired documents lead to loss of privileges and inability to treat patients, which need to be avoided at all costs. Also, the application must be filled and all the necessary paperwork needs to be accurate. Any application which is more than 10% incomplete shall be rejected. The paperwork should accurately reflect your AMA (American Medical Association) information. Any history of malpractice claims, lawsuits, drug usage, or rehabilitation should also be mentioned to avoid termination at a later stage.

Wrapping Up

To make your entire medical credentialing process more efficient and cost-effective, make sure to connect with ProLocums or Credidocs. Our team will be glad to help you.