Wanna Get Paid…Here’s the Starting Line

 In Articles, Credentialing, Policy Updates

Recent changes in credentialing requirements include updating provider information whenever there is a renewal of medical license, DEA, or board certification. Failure to update the provider’s records with the renewed document(s) prior to the current expiration date on file may result in the provider’s termination from network participation.

In order to avoid termination from a particular network, promptly provide hard copies of all renewals to include medical license, DEA, board certification, and malpractice certificates to your credentialing specialist. Payors typically require the following set of minimum information to credential a new provider:

Licenses and certificates

  1. Original license
  2. Up-to-date renewal of license
  3. Original diploma for Masters or Doctorate
  4. Specialty diplomas or certificates, include renewals
  5. Current DEA registration

Personal documentation

  1. Start date with new group
  2. CAQH Login and Password
  3. NPPES Login and Password
  4. Drivers license
  5. SSN, DOB
  6. Up-to-date Curriculum Vitae/Resume **Date spans must be in MM/YYYY format, separate letter accounting for any gaps 3 months or longer in education/work history**
  7. Official NPPES letter (usually received via email)
  8. Insurance I.D. #s (if previously enrolled) and eligibility dates
  9. Previously completed Medicare CMS 855I Form if applicable
  10. Legal documents pertaining to legal status if not a U.S. born citizen:
    • Passport
    • I-94 card
    • Green card
    • Certification of Citizenship
    • Proof of Employment Eligibility

Practice Information

  1. Current professional liability insurance policy face sheet (showing the physician’s insurance liability coverage)
  2. List of insurance companies physician or group is affiliated with, or looking to credential with
  3. Group’s TIN
  4. Physical addresses of all practice locations, including:
    • Phone and Fax numbers
    • Daily hours

If you have any questions on credentialing or contracting with payors, please contact Amy C. Dunatov at 919.442.1100 or a.dunatov@msochealth.com.

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