Credentialing 101 for New Physicians

Having the necessary documents ready puts you in the best position for a timely career move.

Many physicians are surprised to learn that credentialing with payors for a new position can take 90-120 days.

Unlike most other professions, doctors are subject to several timelines that determine when they can begin seeing patients in a new job. Licensing and credentialing processes are determined by states and payors and can add months of lead time to starting a new position.

The credentialing process can often feel like getting a mortgage in that there’s always just one more piece of information that you’re asked for. Having all the necessary documents ready to go will put you on the best track to a target start date.

Know the Timelines

• Application for and receipt of a state medical license can take 4-6 weeks.
• Credentialing with commercial payors can take 90-120 days and cannot commence until state licensure is received.
• Credentialing for physicians coming out of fellowship cannot start until July 1, following completion of their training, and may be contingent upon the receipt of board results. That means new fellows will likely not be able to start new positions until the fall.

That last point comes as a big surprise to many new fellows when they learn they will be benched for a few months following graduation. This is a good stretch of time that can be best used to make geographical moves and get families settled.

Gather Passwords

Depending on the size of the practice you’re joining, you may be working with an in-house credentialing team or an outside vendor to walk through the process. They will request access to some of your dashboards, so have your credentials ready to go when they ask.

• NPPES/PECOS (NPI/Medicare) ID, Login, and Password
• CAQH Provider ID, Login, and Password

Update your CV

It may seem like a fine point, but payors prefer to have CVs formatted in a specific fashion. You can save time by updating your CV to list the dates of employment and education in MM/YYYY format. If you’ve signed a contract with an employer, they may ask you to add your new position as well.

Scan Your Documents

Payors will require a variety of documents that confirm educational accomplishments and citizenship. Make sure they are scanned in color and that the file names include your name and a reference to the document type so they are easy for the credentialing team to reference.

• Driver’s license or passport
• Social security card
• Proof of citizenship if born outside the United States
• State medical licenses (current and former)
• Federal DEA certificate
• State CDS certificate
• Malpractice insurance certificate for last 10 years (current/former employers)
• Medical school diploma
• Residency diploma
• Fellowship diploma
• American Board of Allergy & Immunology certificate
• Educational Commission for Foreign Medical Graduates certificate, if applicable
• Other Documents and Applications

You will also likely be asked to complete applications specific to the practice you are joining, which may include supplying additional information for background checks and medical malpractice coverage.

• MedPro application
• Hospital privileges application

Whether you are joining a practice as a new physician or aligning your practice with a larger company through acquisition, the credentialing team will need every item on their checklist in order to proceed. Having all documents and passwords pulled together will put you in the best position to be fully credentialed by your start date.