Why is it important to keep credentialing files?

The term credentialing, when used in conjunction with a physician’s practice, is the process of substantiating a physician’s credentials with required documents such as a state license, diploma, continuing education credits, third-party payer registration, professional liability insurance coverage, tax identification number, and business permit.

The secret to successful credentialing is up-to-date files. The files should contain a copy of just about every official document pertinent to the physician. Besides coping with payers, a credentialing file is useful for renewing hospital privileges, joining a medical group, affiliating with an independent physician association (IPA), updating a Drug Enforcement Agency (DEA) license, obtaining new malpractice insurance, and renewing a state license. A list of the common elements of a credentialing file include: physician’s diploma, state license(s) to practice, specialty board certification, membership in professional societies, curriculum vitae, certificate from DEA, proof of professional liability (i.e., malpractice) insurance, social security number, tax identification number (for business), state fictitious name permit, city business license, Medicare personal identification number (PIN), Medicare unique physician identification number (UPIN), identification number(s) for other third-party payer(s).