Practical Approach to Physician Credentialing
In the day to day operation of our Infusion Therapy Intake Department there are many details to be captured. This process includes the task of verifying a physician who is referring to the organization has appropriate credentials. This credential may be a Medical Doctor or Doctor of Osteopathy.
Included in your software is a field for:
- Physician license number
- Expiration date for that license
- UPIN # unique to each physician
- DEA number -now required for Medicare Plan D
- Expiration date of the physician’s license
- NPI number (NOT the Physician Group # , the individual Physician NPI #)
In some programs a field is included for the initials of the person verifying the credential and a field to use for running a report to recheck credentials when the current license expires. When this data is available, a process can be instituted to run a report showing expiration dates and this can then be used to routinely update expired license numbers on a monthly basis.
This process is an important element in the credentialing process of your accreditation organization. It is also important that pharmacy be taking orders from a qualified referral source.
The availability of online resources has made this process much easier than in the era of telephonic verification. Each State will have a website from which the information regarding licensing can be obtained.
Below are listed sites for the State of California to be utilized for the process:
For MDs:
http://www2.dca.ca.gov
For DO
http://www2.dca.ca.gov
UPIN (National site)
http://upin.ecare.com/
The intake process for infusion organizations needs to include:
- Request for Physician DEA number
- Request for Physician NPI number
Sites are available to gather the DEA number but they charge a subscription fee rather than the free sites listed above. Sites will become available with NPI data bases once the number has become a required claim element, now scheduled for May 23, 2007.
The maintenance of databases on a routine basis can save an organization time and money. Since Physician data relates to regulatory compliance this is important to your operation. Clean Physician data can result in a clean claim with prompt payment. All of which contribute to good business practice.