Run Provider Credentialing and Privileging File Checklist — Free

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 critical (required)

Record the date and time the file review was completed.

Reviewer signature completed critical (required)

Inspector or reviewer signs to confirm the file review.

Identity, Appointment, and Scope

Government-issued identity verification present critical (required)

A copy or documented verification of provider identity is present in the file.

Yes No N/A

Current application or reappointment form completed and signed critical (required)

The credentialing application is complete, current, and signed by the provider.

Yes No N/A

Requested privileges or scope of practice documented critical (required)

The file clearly identifies the privileges, scope, or services requested and reviewed.

Yes No N/A

Appointment or approval dates documented

Initial appointment, reappointment, or approval dates are present and consistent with the file status.

Yes No N/A

Licensure, Registration, and Sanctions

Primary state license verified from primary source critical (required)

Primary source verification of the provider's active professional license is present.

Yes No N/A

License expiration date current critical (required)

Record the license expiration date and confirm it is current at the time of review.

DEA registration verified when prescribing authority applies critical (required)

DEA registration is present and current for providers authorized to prescribe controlled substances.

Yes No N/A

Controlled substance registration or state equivalent verified when required

Any required state controlled substance registration or equivalent is documented.

Yes No N/A

Sanctions and exclusions screening documented critical (required)

File includes screening for exclusions, sanctions, or disciplinary actions as required by policy.

Yes No N/A

NPDB query completed within required review cycle critical (required)

National Practitioner Data Bank query is documented and within the organization's required timeframe.

Yes No N/A

Primary Source Verifications and Education

Medical school or professional education verified from primary source critical (required)

Primary source verification of education is present in the file.

Yes No N/A

Residency, fellowship, or training verified from primary source critical (required)

Training completion is verified from the issuing institution or primary source.

Yes No N/A

Board certification status documented when applicable

Board certification, board eligibility, or non-certification status is documented as applicable.

Yes No N/A

Work history or employment gaps reviewed

The file includes a review of work history and any unexplained gaps are addressed.

Yes No N/A

References or peer recommendations present when required

Required references, peer recommendations, or professional attestations are included.

Yes No N/A

Malpractice history documented and reviewed

Any malpractice claims history, coverage history, or explanation is documented per policy.

Yes No N/A

Competence, Privileges, and Performance

Current competence documentation present critical (required)

The file includes current competence evidence such as evaluations, case logs, peer review, or performance data.

Yes No N/A

Privilege-specific competency documented critical (required)

Competency evidence supports each requested privilege or scope item reviewed.

Yes No N/A

Proctoring or supervision requirements documented when applicable

Any required proctoring, supervision, or focused professional practice evaluation is documented.

Yes No N/A

Clinical performance or quality review evidence present

Quality metrics, peer review, or performance monitoring evidence is present when required by policy.

Yes No N/A

Privilege renewal or limitation status documented critical (required)

Any granted, limited, suspended, or denied privileges are clearly documented.

Yes No N/A

File Completeness and Final Disposition

All required documents present in file critical (required)

The file contains all documents required by policy for the selected review type.

Yes No N/A

Deficiencies or missing documents listed

List any missing documents, expired items, or non-conformances identified during the review.

Corrective action assigned critical (required)

Any deficiencies identified have an assigned corrective action, owner, or follow-up date.

Yes No N/A

Final disposition recorded critical (required)

Select the final outcome of the file review.

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Run: Provider Credentialing and Privileging File Checklist

Inspection Details

Identity, Appointment, and Scope

Licensure, Registration, and Sanctions

Primary Source Verifications and Education

Competence, Privileges, and Performance

File Completeness and Final Disposition

Get your results