Mastering the Practitioner Credentialing Application Process Part II

Welcome back to the second part of our comprehensive guide on filling out a practitioner credentialing application. Make sure to go back and read the first part if you have not already. In this segment, we will continue discussing the essential sections of the application, focusing on healthcare licensures, hospital affiliations, and the all-important attestation and authorization forms. Remember, while we are using the Oregon practitioner credentialing application as an example, the information provided applies to credentialing applications in any state. Let’s dive in and explore the remaining sections!

Health Care Licensures, Registration, Certificates, and ID Numbers:

1. Thoroughly Provide License Information: Carefully list all state-specific licenses, including the license type, number, and expiration dates. If you are a prescriber, include your DEA number and controlled substance registration details.
2. Individual NPI and Other IDs: Provide your NPI Type 1 number and other relevant identifiers, such as Medicare or Medicaid (DMAP numbers in Oregon).
3. Other State Licensures: If you have licenses in other states, list them with the necessary details. Remember, even if they are expired, you must include them all.

Hospital and Other Healthcare Facility Affiliations:

1. Comprehensive List: List all healthcare institutions where you have or had clinical privileges and staff membership in reverse chronological order. Include current affiliations first, followed by previous affiliations.
2. Complete Information: Provide the facility’s name, contact details, address, status (active, courtesy, provisional, or allied health), and the appointment dates.
3. Admitting Privileges: If you do not have hospital admitting privileges, explain your plan for continuity of care for your patients requiring admission. This is crucial, as organizations want assurance of patient care even in your absence.

Peer References:

1. Choose Carefully: Select individuals who have directly observed your clinical skills and competence. Avoid using relatives as references.
2. Medical Staff Members: Include at least one member from the medical staff of each facility where you have privileges.

Professional Continuing Medical Education (CMEs):

1. Attach Additional Sheets: If necessary, attach separate sheets with a comprehensive list of your CMEs from the last two years.
2. Include Relevant Information: List the title, date, location, and any credits earned for each CME activity.

Professional Liability Insurance:

1. Current Liability Coverage: Provide details about your professional liability insurance, including the broker or representative’s name, claim limit, and policy type (claims made or occurrence).
2. Previous Coverage: List all previous professional liability carriers within the last five years. Even if you had multiple policies under the same carrier, include each separately.

Attestation Questions:

1. Practitioner’s Responsibility: The practitioner should review and answer these questions themselves. The application must not be completed by anyone else on their behalf.
2. Truthful Responses: The practitioner should attest to the accuracy and truthfulness of their responses by signing and dating this section.

Authorization and Release of Information Form:

1. Review Carefully: The practitioner must thoroughly read and complete this section, authorizing the release of necessary information for credentialing purposes.
2. List Relevant Organizations: If someone else is assisting with the application, the practitioner should list their name and the organization they represent in this section.

Confidential Professional Liability Action Details:

1. File Separate Pages: If any professional liability claims or lawsuits have been filed against the practitioner, they must complete Attachment A for each case on separate pages.
2. Verification: The practitioner should sign and date this section, attesting to the accuracy of the information provided.

Completing a practitioner credentialing application demands careful attention to detail and comprehensive documentation. You can streamline credentialing by diligently providing accurate information, including thorough explanations and attaching additional sheets where necessary. Remember to have the practitioner review and complete the attestation questions and authorization forms personally. Double-check for errors, spelling, or omissions as you finalize the application. Once completed, save the application for future updates and submit it confidently. You’re one step closer to joining insurance networks, hospitals, or healthcare organizations. Wishing you success in your credentialing journey!