Documents needed for provider credentialing

Your provider has to be credentialed at each location they service, each payer panel they are accepted on, each plan they’re participating in.

Categorized as Operations Tagged

In healthcare, provider credentialing is a pain.

A necessary evil, justifiably so.

Your provider has to be credentialed at each location they service, each payer panel they are accepted on, each plan they’re participating in.

It’s a matrix that you need to maintain.

Without that, your revenue cycle management processes will be dead on arrival.

Here are some required payer documents:

  • Provider Licenses (you can upload this as PDF or fax to us)
  • Malpractice Insurance (We will need the certificate of insurance – you can upload this as PDF or fax to us)
  • DEA (federal) and state CDS certificates (you can upload this as PDF or fax to us)
  • Board Certification (you can upload this as PDF or fax to us)
  • Diploma – copy of highest level of education (you can upload this as PDF or fax to us)
  • Latest “resume” (this needs to show the current employer)
  • IRS Form W-9
  • Driver’s license (has to be current)

For your business (aka – legal entity) we need the following documents, You can fax these to us or upload them using our CRM:

  • IRS form CP 575 or replacement letter 147C. We need this for EIN verification. IRS would have sent you this letter when you obtained an EIN from them (when you first registered your business). Medicare will NOT process your application without the 575 or the replacement 147C.
  • Business Licenses.
  • If you are a therapy facility, we would need a copy of your office lease as well.
  • If you are enrolling in Medicare, we would need a Letter of bank account verification.

We *might* need various other documents (based on the payer). These *might* include:

  • Collaborative Agreement (required for Nurse Practitioners)
  • Admitting Arrangement letter (required for providers who do not have hospital admitting privileges). Do keep in mind that we also help with hospital admitting privileges.
  • Prescribing arrangement letter. If for some reason, your providers do NOT hold a DEA certificate.

For provider(s) educated outside of the USA, you need the following:

  • ECFMG Certificate (if educated outside of The United States)
  • Passport or other citizenship documents

Service location requirement

You need to have a service location before you can be credentialed.

There are no 2 ways about it. You cannot use your home address.

You CAN, however, list the address of an office space you’re having built out or taking over.

But, you cannot do this more than 30 days prior to starting to see patients at that location.