Get Provider Credentialing Checklist Template

Filling out the Provider Credentialing Checklist Template is an essential step for providers to ensure compliance with credentialing requirements. This guide outlines clear steps to help you complete the form accurately and efficiently online.

Follow the steps to complete the Provider Credentialing Checklist Template

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by selecting whether this is for initial credentialing or recredentialing, noting that recredentialing is required every two years.
3. Enter the provider's name and select the provider type from the listed options, including Registered Nurse, Licensed Practical Nurse, Certified Medical Assistant, or Other.
4. In the credentials and privileging section, provide details for each type of verification required, such as licensure. Specify the verification source and state licensing board, as well as the date verified or reviewed.
5. Document the initials of the person who verified or reviewed each credential and include expiration dates where applicable.
6. Provide additional information regarding education/training and current competence to practice. Include health/fitness evaluations relevant to requested privileges.
7. Indicate whether a National Practitioner Data Bank (NPDB) query is required by selecting 'Yes' or 'No.'
8. If applicable, provide a government-issued picture ID and confirm that the statement required is accurate.
9. Proceed to fill out the supervisory evaluation, ensuring compliance with the job description outlined in the form.
10. Complete any additional components related to credentials and privileging, including verification sources and confirmations of statements.
11. Finally, after reviewing all entered information, users can save changes, download, print, or share the form as needed.

Complete your Provider Credentialing Checklist Template online today to ensure timely and accurate credentialing.