Operational Toolkits
Clinician Credentialing Document Checklists
Ensure every provider onboarding packet is 100% complete before filing with commercial health plans or Medicare.
Physician (MD/DO)
Download Clean PDF ChecklistPhysician (MD / DO) Credentialing Checklist
Required Verification Documents (6)
Medical School Diploma & TranscriptsOfficial copy from accredited LCME or COCA institutionSource: Primary Medical School Verification
State Medical License (Full & Unrestricted)Active license in all practice and telemedicine statesSource: State Medical Board API
Federal DEA RegistrationMust match practice physical address or multi-state schedulesSource: US Dept of Justice DEA Registry
Certificate of Insurance (Malpractice COI)$1M/$3M minimum limits with retroactive date specifiedSource: Insurance Carrier Direct Verification
Board Certification CertificateABMS or AOA recognized specialty board certificateSource: ABMS CertiFACTS Registry
5-Year Work History & Gap ExplanationContinuous timeline with explanations for gaps > 30 daysSource: Provider Attestation & Prior Employers
Common Pitfalls & Payer Delay Causes
- Submitting an address on the DEA certificate that does not match the practice tax ID location.
- Leaving a 45-day gap in work history between residency graduation and first employment unexplained.
- Allowing the 120-day CAQH attestation to expire while payer committee review is pending.
Nurse Practitioner (NP)
Download Clean PDF ChecklistNurse Practitioner & PA Credentialing Checklist
Required Verification Documents (4)
Graduate Nursing Degree & CertificationMSN or DNP certificate plus ANCC / AANP board certificationSource: ANCC / AANP Primary Verification
Advanced Practice Registered Nurse (APRN) State LicenseActive state APRN and RN licenses in practice jurisdictionsSource: State Board of Nursing Registry
Collaborative Practice / Supervisory AgreementExecuted agreement with supervising MD/DO where required by state lawSource: Internal Clinical Compliance File
State Controlled Substance Certificate (CSR / CDS)State-level prescriptive authority credential where mandatedSource: State Board of Pharmacy / Controlled Substance Board
Common Pitfalls & Payer Delay Causes
- Failing to file supervisory physician details in states with restricted practice authority.
- Mismatch between RN license renewal cycle and APRN prescriptive authorization.
Licensed Clinical Social Worker (LCSW)
Download Clean PDF ChecklistBehavioral Health (LCSW, LMFT, LPC, Psychologist) Checklist
Required Verification Documents (4)
Master's or Doctoral Degree in Social Work / PsychologyFrom CSWE or APA accredited institutionSource: University Registrar Direct PSV
Independent Clinical Practice State LicenseHighest level independent clinical license (e.g. LCSW, PsyD)Source: State Behavioral Health Licensure Board
Professional Liability Malpractice InsuranceStandard $1M/$3M coverage tailored for outpatient mental healthSource: Carrier Policy Schedule
Supervised Clinical Hours DocumentationVerification of 3,000+ supervised post-graduate hours where requiredSource: State Board Dossier
Common Pitfalls & Payer Delay Causes
- Applying to commercial panels with associate-level or provisionally licensed credentials without billing supervisor NPI.
- Not submitting state Medicaid registration before applying to regional Medicaid MCO mental health panels.
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