The Physician Credentialing Checklist

As you prepare to launch your career with your new practice, your employer will reach out to initiate the physician credentialing process.  Because this process can take 4-6 months, you’ll want to be prepared with the documentation you’ll need so you can respond in a timely manner.  Below is a checklist of documents you may be asked to provide for the provider credentialing process to start. Your responsiveness will help ensure you can start seeing patients on your first day!

20 Documents You’ll Need For Your Credentialing Process:

1. Driver’s License
2. Copy of Social Security Card or SS# 
3. Country, State, and City in which you were born
4. Mother’s Maiden Name 
5. Visa (if applicable)
6. Other name(s) besides name listed on professional license and timeframes that were used.
7. Professional Medical License(s) for all states that are current
8. DEA Certificate
9. State CDS/CSR Certificate, if applicable
10. Current Professional Liability Coverage Declarations Page- if you are coming out of Fellowship this can be obtained from your Program Director
11. Education certificates/diploma: i.e. ECFMG, residency certificate, fellowship certificate
12. Board Certification Certificates (if in Certification process, provide status) 
13. Current Curriculum Vitae (CV). Dates must be in MM/DD/YYYY format and should include employment with your new employer.
14. CME completed for previous two (2) years
15. CPR/BLS, ACLS Provider Card 
16. Documentation of most recent TB skin test. If previously tested positive, provide most recent chest x-ray. 
17. Documentation of most recent Flu shot.
18. Case log(s) for previous 24 months.
19. Headshot photograph
20. Three peer references that have worked with you in the last 12 months, include name, mailing address, phone number, fax number, and email addresses for each. (Tip: pick individuals that you know will give a timely response!)

You may also be asked for your login information so that your employer’s credentialing team can assist with the process:

• National Provider Identification Number (NPI) User ID and Password 
• Council for Affordable Quality Healthcare (CAQH) ID, Username and password