The Annual Credentialing Check-Up for Healthcare Practitioners

Checkup ImageBusy healthcare practitioners are often asked to create and maintain database profiles related to credentialing which are in turn made available to consumers or plans. The list is growing.  With an increase in e-signing and check-box attestations, providers may be skipping some fine print.  Medical professionals should review all documents prior to signing, and this includes the electronic acceptance of terms related to databases.

Let’s take the NPI database (NPPES) as an example.  Every healthcare practitioner and organization must have an NPI.  Since 2006 NPIs have been created and the NPI has become the common identifier for providers of health services.  However, many practitioners fail to update their NPI profile when re-locating or changing a main business or practice address, or leaving a practice setting.  The NPI application terms of acceptance state the following: “I agree toNPPESlogobluResized keep the NPPES updated with any changes to data listed on this application form within 30 days of the effective date of the change.”  Further, are practitioners taking their user IDs and passwords with them?  Our experience tells us they are not.

For example, when a physician graduates from a training program, their NPI profile lists the taxonomy code as a student.  Failure to update the taxonomy code to the practicing specialty can delay enrollment in health plans including Medicare. Medicare also requires that healthcare providers notify them with any change to contact information, practice information, affiliations and funds transmission accounts.  Failure to maintain Medicare databases are creating re-validation delays and unfortunately some disenrollment resulting from Medicare not being able to contact providers.  One returned piece of mail (a do not forward or DNF) will result in a suspension of billing privileges.

Another example comes from New York.  When a physician renews their medical license, they certifying that they have “submitted information to or updated your profile which appears in the NYS Office of the Professions website”.  See below:

‘Pursuant to Subdivision 4 of Section 2995-a of the Public Health Law, physicians must report information for inclusion in the Department of Health Physician Profile and as a condition of registration renewal under Article 131 of the State Education Law update his/her profile within six (6) months prior to the expiration date of the physician's registration period.’

Click here for more information from NYS Office of the Professions website.

Medical practitioners should be mindful of the need to review and correct their information and that of their practice periodically and, at a minimum, annually.

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