Credentialing is a document-intensive process. Having these essential files ready speeds up approval with insurers and healthcare networks.
🔹 Mandatory Documents for All Providers
1. Personal Identification
✔ Government-issued photo ID (driver’s license/passport)
✔ Social Security card (or W-9 for tax verification)
2. Professional Licenses & Certifications
✔ Active state medical license(s)
✔ DEA registration (if prescribing controlled substances)
✔ Board certification (if applicable)
✔ CDS certificate (for states requiring it)
3. Education & Training Proof
✔ Medical school diploma
✔ Residency/fellowship certificates
✔ Internship logs (if recently graduated)
4. Work History & References
✔ CV/resume (last 5-10 years of employment)
✔ Malpractice insurance (current certificate)
✔ Peer references (typically 2-3 letters)
5. Practice Details
✔ NPI confirmation (Type 1 for individual, Type 2 for group)
✔ CLIA waiver (if performing lab tests)
✔ Hospital affiliation letters (if applicable)
🔹 Payer-Specific Requirements
Medicare (CMS-855 Forms)
✔ CMS-855I (Individual) or 855B (Group)
✔ IRS EIN confirmation
✔ Electronic Funds Transfer (EFT) authorization
Medicaid (Varies by State)
✔ State-specific enrollment forms
✔ Medicaid provider agreement
Private Insurers
✔ Payer-specific applications (e.g., UnitedHealthcare, Aetna)
✔ Fee schedule agreements
🔹 Pro Tips for Smooth Credentialing
✔ Keep digital copies of all documents (PDF format)
✔ Track expiration dates for licenses/DEA
✔ Use CAQH ProView to streamline commercial payer enrollment
