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Just Graduated: Now what?

As a medical provider, what should you do next?

Congratulations on graduating! Now, you can choose where to start your career. Will you join an existing clinic or try to start your own? Either way, if you are going to accept medical insurance from patients, you need to be credentialed. Entering the healthcare field as a provider is exciting, but navigating the credentialing process can be daunting. Here's a breakdown of what you need to know:

What is credentialing?

Credentialing is the process of verifying a healthcare provider's qualifications to practice. It ensures you have the necessary education, training, licensure, and experience to safely and effectively care for patients. Once credentialed with an insurance company, you may bill and be paid for the services you provide.

The process:

  • Credentialing: Verifying your education, training, licenses, and work history.

  • Contracting: Allowing you to bill and be paid for those services.

What information is needed?

Expect to provide the following documents during credentialing:

  • Education and training: Transcripts, diplomas, residency completion certificates, etc.

  • Licenses and certifications: State license, board certifications, DEA registration (if applicable).

  • Work history: References, CV, performance evaluations, etc.

  • Professional liability insurance: Proof of coverage at the location you are providing services.

  • Personal information: Contact details, social security number, linked to NPI and CAQH accounts.

Tips for graduating providers:

  • Start early: Begin the credentialing process as soon as possible, ideally several months before you graduate. It can take 1-6 months to complete the process.

  • Understand your state and specialty requirements: Each state has specific licensing and board certification requirements for different professions. Research your specific needs.

  • Stay organized: Keep copies of all your documentation and communicate with your credentialing specialist. This includes diplomas, transcripts, licenses, board certifications, malpractice insurance information, work history, and references.

  • Be proactive: Don't wait for someone to ask for information. Be proactive in providing everything they need. A specialist should give you a list of what's needed but you can send the general documents listed above.

  • Ask for help: If you're unsure about anything, don't hesitate to ask your credentialing specialist for clarification. You have a right to know what's going on with your enrollment application(s).

Additional tips:

  • Network with other providers: Get advice from experienced professionals about the insurances most common in your area. See what plans might be beneficial to be in or out of network with. Contracts and fee schedules vary with provider type. Ask for information from a provider that offers the same services you do.

  • Consider attending workshops or seminars: Many organizations offer educational resources on the benefits of enrolling with insurance companies.

  • Be patient and persistent: The process can be frustrating, but staying organized and proactive will help you get through it.

Remember, credentialing is a complex process, but with preparation and organization, you can navigate it smoothly and start your career as a licensed provider confidently.

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