Credentialing and Privileges: Simplifying the Process.

Verifying providers against the 12 criteria listed below will aid you in determining whether they are appropriately qualified to provide healthcare services:

1. Identification Proof

• Government-issued photo identification • National Provider Identifier (NPI) number • I-9 documentation labeled List A, List B, or List C as defined on the form • Visa or employment verification card

2. Education and Training Proof of course completion and completion dates from a domestic or foreign medical school, internship, residency, fellowship enrollment, clinical degrees, and any other relevant experiences in MM/YY format.

• Fifth Pathway certification, if applicable; and validation from the Educational Commission for Foreign Medical Graduates (ECFMG).

4. Professional Licensure

• A complete list of all professional licenses and/or copies of all professional licenses. The issuing state, license type, license number, status, and issue and expiration dates must all be included.

5. DEA registration, as well as state DPS and CDS certifications

• A complete list, as well as copies of Drug Enforcement Administration (DEA), Department of Public Safety (DPS), and Controlled Dangerous Substances (CDS) certificates. These must include the issuing state, the status, the registration number, as well as the issue and expiration dates.

6. Board Certification

• A complete list of Board-specialty certifications held, including the dates of original, recertification, and expiration.

7. Affiliation and Work History

• A chronological list of all facilities where the provider has worked or has clinical privileges (academic appointments, hospitals, practise groups, surgery centers, etc.). Start date, date on staff, employment or staff status, verification or good standing, and end date must all be included.

• Any time gaps must be explained.

8.   Criminal Background Disclosure

•  Federal, state, and county databases for criminal background checks

9. Disclosure of Sanctions

•  Both federal and state

10. Health Status

•  Records of physical or mental illnesses that may have an impact on work

11. NPDB

• Healthcare-specific information on criminal convictions or civil judgments in state or federal courts.
• A history of malpractice and hospital sanctions

12. Professional Liability Insurance

• Extensive list of insurance companies. This includes the dates and types of coverage
• A list of cases that are open, pending, settled, closed, or dismissed.
• Valid Certificate of Insurance (COI)

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