Provider Credentialing and Privileging File Checklist

Inspection checklist for reviewing a provider credentialing and privileging file, including primary source verifications, licenses, DEA registration, NPDB query, competence documentation, and related compliance records.

Inspection Details

• Provider name and file identifier recorded
  Enter the provider's full name and internal file or record identifier.
• Review type selected
  Select the type of credentialing review being performed.
• Review date documented
  Record the date and time the file review was completed.
• Reviewer signature completed
  Inspector or reviewer signs to confirm the file review.

Identity, Appointment, and Scope

• Government-issued identity verification present
  A copy or documented verification of provider identity is present in the file.
• Current application or reappointment form completed and signed
  The credentialing application is complete, current, and signed by the provider.
• Requested privileges or scope of practice documented
  The file clearly identifies the privileges, scope, or services requested and reviewed.
• Appointment or approval dates documented
  Initial appointment, reappointment, or approval dates are present and consistent with the file status.

Licensure, Registration, and Sanctions

• Primary state license verified from primary source
  Primary source verification of the provider's active professional license is present.
• License expiration date current
  Record the license expiration date and confirm it is current at the time of review.
• DEA registration verified when prescribing authority applies
  DEA registration is present and current for providers authorized to prescribe controlled substances.
• Controlled substance registration or state equivalent verified when required
  Any required state controlled substance registration or equivalent is documented.
• Sanctions and exclusions screening documented
  File includes screening for exclusions, sanctions, or disciplinary actions as required by policy.
• NPDB query completed within required review cycle
  National Practitioner Data Bank query is documented and within the organization's required timeframe.

Primary Source Verifications and Education

• Medical school or professional education verified from primary source
  Primary source verification of education is present in the file.
• Residency, fellowship, or training verified from primary source
  Training completion is verified from the issuing institution or primary source.
• Board certification status documented when applicable
  Board certification, board eligibility, or non-certification status is documented as applicable.
• Work history or employment gaps reviewed
  The file includes a review of work history and any unexplained gaps are addressed.
• References or peer recommendations present when required
  Required references, peer recommendations, or professional attestations are included.
• Malpractice history documented and reviewed
  Any malpractice claims history, coverage history, or explanation is documented per policy.

Competence, Privileges, and Performance

• Current competence documentation present
  The file includes current competence evidence such as evaluations, case logs, peer review, or performance data.
• Privilege-specific competency documented
  Competency evidence supports each requested privilege or scope item reviewed.
• Proctoring or supervision requirements documented when applicable
  Any required proctoring, supervision, or focused professional practice evaluation is documented.
• Clinical performance or quality review evidence present
  Quality metrics, peer review, or performance monitoring evidence is present when required by policy.
• Privilege renewal or limitation status documented
  Any granted, limited, suspended, or denied privileges are clearly documented.

File Completeness and Final Disposition

• All required documents present in file
  The file contains all documents required by policy for the selected review type.
• Deficiencies or missing documents listed
  List any missing documents, expired items, or non-conformances identified during the review.
• Corrective action assigned
  Any deficiencies identified have an assigned corrective action, owner, or follow-up date.
• Final disposition recorded
  Select the final outcome of the file review.