Physician Credentialing Mistakes to Avoid

Opportunity for human error abounds where physician credentialing is concerned, which can expose your medical practice to financial loss.

Opportunity for human error abounds where credentialing is concerned, which can expose your practice to financial loss.

The most common oversights include failure to complete forms fully, submitting an expired DEA number or license, and leaving data fields blank, says Patrick Boyle, vice president and director of managed care for Catalyst Consulting. "Physicians sometimes leave information off their application, like their work history date or peer reference," he says.

In some cases, providers may also have malpractice insurance for the practice they were leaving, but not for the one they're joining, which can delay the credentialing process. "That's usually the hiccup; getting that malpractice piece in place," says Boyle. "What happens is if the CAQH doesn't have everything it needs to be deemed complete, none of the plans can go pull that information," he says.

Solo practices that recruit a new physician would also be wise to review their payer contracts during the credentialing process. "Some plans may want that practice to restructure their contract as a group contract," says Boyle.

As they onboard new physicians office administrators need to be sure that credentialing information is accurate and submitted in a timely fashion.