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Starting your own medical practice is an exciting process but may seem complicated from the get-go: finding the perfect location, setting up your staff, building your brand, and achieving profitability. One of the most important first steps on the road to financial success is fulfilling your provider enrollment—becoming affiliated with insurance companies so that you can receive third-party reimbursement. Credentialing is required for in-network payments from insurance providers.
Documentation for Proof of: | MD/ DO | NP/ PA |
Medical School Degree | X | X |
Internship | X | |
Residency | X | |
Board Certification | X | X |
The Educational Commission for Foreign Medical Graduates / Fifth Pathway* | X | |
Drug Enforcement Agency (DEA) | X | ** |
Controlled Dangerous Substance License** | X | |
Curriculum Vitae (YY/MM Format) | X | X |
State Medical License | X | X |
Council for Affordable Quality Healthcare | X | X |
Driver’s License | X | X |
Malpractice Certification | X | X |
Explanation of Any Malpractice | X | X |
Any Other Certifications (CPR, CMEs, BLS, etc) | *** | *** |
*For Non-US Educated Only, Practicing in the U.S.
** If State Requires
*** Not Required But Nice to Have for Credentialing
Important: You can’t apply for credentialing until you have an Employer ID Number (EIN), business location, and a phone/fax number.
Once you have these things, you’re on your way to becoming profitable. Make sure that when you open your doors to start seeing patients, you avoid the financial burden by being credentialed.
Our collaborative efforts on all of the above steps are how we have helped each other be prepared for the credentialing process. There are a few other things you will need to provide in this step.
So, get these lined up as quickly as possible and add them to the required name, address, and phone/fax numbers.
Watch: The Dos & Don’ts of Medical Credentialing Webinar
Do not forget: It’s not just MDs and DOs who need to be credentialed. Any individual who signs off on any portion of any billing content must be credentialed. This means Nurse Practitioners and Physician Assistants as well.
The next likely step after being credentialed is to pick the EHR your practice is going to use. If you’ve chosen PrognoCIS to assist in the credentialing process, you might be pleased to find out we are also an award-winning EHR. There are many benefits to having your credentialing service provider and your EHR under the same roof.
Credentialing usually needs to be renewed every two to three years. Since your EHR is already in regular contact with the insurance providers that you connect with for billing purposes, PrognoCIS can alert you about credential renewal and provide additional assistance along the process.
If your credentialing service and your EHR are different companies, you have to wait for notification from the provider, gather the identifying material, send it back to the provider and wait for them to process it—all while awaiting payment. Make sure you are climbing the ladder to success.
If you a Healthcare Provider who is tired & frustrated with dealing with all of the paperwork and processes to become in-network with insurance companies, Let our team of experts at PrognoCIS help you!
PrognoCIS delivers credentialing services that streamline the whole process of opening your own medical practice.
Contact PrognoCIS to Discuss the EHR Needs of Your Medical Practice
PrognoCIS offers powerful solutions to medical practitioners which include Practice Management, Telemedicine Solutions, and Medical Credentialing. For more tips on value-based healthcare, sign up for our EHR newsletter and stay updated with the latest Prognocis News here
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