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HRSA Credentialing/Recredentialing Checklist Licensed Independent Practitioners 2012-2025 free printable template

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Credentialing/Re credentialing Checklist Licensed Independent Practitioners ? Initial Credentialing/Privileging ? Re credentialing/Privileging (Required every two years) Provider Name: Provider Type:
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How to fill out credentialing checklist form

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How to fill out HRSA Credentialing/Recredentialing Checklist Licensed Independent Practitioners

01
Begin by downloading the HRSA Credentialing/Recredentialing Checklist for Licensed Independent Practitioners from the HRSA website.
02
Carefully review the checklist to understand the required documents and information needed.
03
Gather all necessary documentation, including licenses, certifications, and any relevant performance evaluations.
04
Complete each section of the checklist accurately, ensuring that all information is up-to-date and matches the supporting documents.
05
Double-check for any missing items or errors before finalizing the checklist.
06
Submit the completed checklist along with all supporting documentation to the appropriate HRSA office.

Who needs HRSA Credentialing/Recredentialing Checklist Licensed Independent Practitioners?

01
Licensed Independent Practitioners who provide services under HRSA programs.
02
Healthcare organizations that are applying for or maintaining HRSA funding.
03
Any practitioners participating in HRSA-supported training and academic programs.
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Credentialing is "the process of assessing and confirming the license or certification, education, training, and other qualifications or a licensed or certified healthcare practitioner." Privileging is "the process of authorizing a health care practitioner's specific scope and content of patient care services."
Credentialing Documents Needed for New Physicians Personal information like email address, street address, phone, etc. Driver's license. Social Security card. Recent photograph signed and dated in the margin. Medicaid number. Medicare number. Copy of National Provider Identifier (NPI#) documentation and confirmation letter.
licensed or certified healthcare practitioner, including employed, contracted, volunteers, and locum tenens (i.e., temporary) practitioners, at all health center sites. ➢Credentialing: The process of assessing and confirming. the qualifications of a licensed or certified healthcare practitioner.
The three primary phases of provider credentialing are as follows: Gather Information. A healthcare facility or health insurance plan asks the provider for information on his or her background, licenses, education, etc. Check the Information. Award the Provider with Credentials.
Provider credentialing is a regulated process of assessing the qualifications of specific types of providers. This important safety check requires providers such as doctors, dentists, and other allied healthcare professionals to show they have the proper education, training and licenses to care for patients.

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The HRSA Credentialing/Recredentialing Checklist for Licensed Independent Practitioners is a comprehensive document used to ensure that healthcare providers meet the required standards and qualifications to deliver care, including verifying licenses, certifications, and education.
Licensed Independent Practitioners (LIPs) who provide direct patient care within healthcare organizations that receive funding from HRSA are required to file the HRSA Credentialing/Recredentialing Checklist.
To fill out the HRSA Credentialing/Recredentialing Checklist, practitioners should gather all necessary documentation related to their professional qualifications, complete each section of the checklist accurately, and provide supporting documents as required.
The purpose of the HRSA Credentialing/Recredentialing Checklist is to establish a standard process for verifying the qualifications of licensed independent practitioners, ensuring patient safety and compliance with federal regulations.
The information that must be reported includes personal information, professional qualifications, employment history, licensure status, board certifications, and any disciplinary actions taken against the practitioner.
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