Practice Credentialing Responsibilities

To view the CCPA initial credentialing criteria in more detail, please review the CCPA Credentialing Policies and Procedures.  Below are links to CCPA's initial credentialing and recredentialing processes.

CCPA's Initial Process

CCPA's Recredentialing Process

Credentialing Tips for Physician and Office Administration Staff

  • Have paper and electronic copies of the physicians’ current support documents (licensures, malpractice insurance, etc.).
  • Create a calendar reminder of when each physicians’ recredentialing/reappointments are due for their hospital reappointments and independent physician association and physician health organizations recredentialing.

  • Federal Drug Enforcement Administration certificate (DEA) should have an address in the state where the physician is practicing.  If the physician’s DEA is pending, they can be credential as long as there is a covering provider with a valid DEA to write the prescriptions on behalf of the practitioner.  Evidence in the form of a signed and dated letter is needed for the credentialing file to show the arrangement for another practitioner (the written name of the practitioner must be listed) to write prescriptions until the DEA is received.

  • The American Board of Medical Specialties (ABMS) board has placed a limit of the number of years after training that an applicant can apply for certification.   “A candidate’s eligibility for Board Certification by an ABMS Member Board expires on the date determined by the Member Board.  That date must be no fewer than three (3) and no more than seven (7) years following the successful completion of accredited training, plus time (if any) in practice as required by the ABMS Member Board for admissibility to the certifying Examination.”

  • The National Provider Identifier (NPI) report shows the physician’s taxonomy number for their specialty.  Ex. Pediatric Taxonomy number is 20800000X.  Therefore, physicians are to make sure that their taxonomy number is correct, and the service address is up to date.  Consequently, some managed care payors view this information and can deny/postpone payments if this report is incorrect. 

  • The physician’s curriculum vitae shall include the beginning and ending month and year for each position of employment experience unless the practitioner has had continuous employment for five years without work gaps in their work history.

  • For initial credentialing only, the physician must provide all information related to their educational background (medical school, residency, internship, and fellowship), and references.  Therefore, keep an electronic and paper copies of all degrees and certificates to submit with your initial credentialing application.