Credentialing Checklist Template

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Credentialing checklist template. Additionally a downloadable spreadsheet template can be found at the end of the article. Msps and credentialing specialists often have the responsibility to make sure that all of the steps in the credentialing process have been executed in the processing of any particular application. By periodically reviewing and refining your credentialing methods and policies you can help improve patient safety minimize the consequences of provider malpractice allegations and better manage your organizations future. Credentialing application checklist in order to proceed contract coordinators must have the following completed documents.

Credentialing is the process by which a health insurance carrier formally assesses a providers qualifications and competency. Group health incorporated ghi hip health plan of new york hip hip insurance company of new york and emblemhealth services company llc are emblemhealth companies. Provider credentialing checklist here is a downloadable credentialing checklist which has a link to our online form which should be completed for each provider within the group. In this article we will use an example to explore what makes up a well constructed credentialing spreadsheet.

Overview and checklist. Before a provider or organization can bill an insurance carrier the provider must first be credentialed by the carrier. Credentialing legal considerations medical staff services department. The credentialing and privileging process is at the heart of healthcare risk management.

If practitioners are included in the contract submit the documentation listed above for each practitioner in addition to the documentation required for hospitalancillaryclinic applications. Credentialing checklist provider name. Provider credentialing checklist. Contractcredentialing check list if hospital ancillary or clinic hospitals ancillaries and clinics are not in caqh.

Completed w 9 at least one if all practitioners share same tax id caqh provider data form fully completed. Credentialing information directly from the entity that originally issued the credential to the practitioner eg state licensing board data sources may include oral written internet cumulative reports and agents of approved sources eg fsmb. Emblemhealth services company llc provides administrative services to the emblemhealth companies. If provider is in caqh please submit per practitioner.