What to Watch Out for When Conducting License Verifications and Credentialing

May 10, 2021 | Credentialing, License Verification, Network Management, Provider Management, Verification

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When conducting provider license verifications and credentialing, it can be easy to miss signals that something may be amiss with a practitioner’s application. Sometimes red flags that should alert an organization to potential problems are obvious, but other times they are more subtle. In either case, it’s important for healthcare organizations to be vigilant and take appropriate action if these red flags appear. Otherwise, you could be risking the safety of your patients and the reputation of your organization.

Once you know what to look for, it becomes easier to spot the warning signs. Here are the most common problem areas in credentialing.

Application Red Flags

  • The application is incomplete
  • The application is unsigned or undated
  • The applicant won’t give permission to contact previous employers or organizations
  • The provider won’t give the requested information
  • The list of references isn’t complete or only includes retired practitioners
  • The information from the applicant doesn’t match the information from their references

Employment History Red Flags

  • Loss of clinical privileges at previous facilities
  • Frequent employment changes (locations or resignations)
  • History of staff or patient complaints
  • Evidence of poor performance
  • Unexplained gaps in work history

Licensing Red Flags

  • Sanctions
  • Provider has license in an undisclosed state
  • Relinquishment of license

Insurance Red Flags

  • Coverage by multiple insurance agencies
  • Adverse actions against provider by insurers
  • Medical liability claims, judgments, or settlements

Although the credentialing process can be lengthy and complex, it’s important for healthcare organizations to ensure that credentialing is done thoroughly and carefully. Negligent credentialing can cause healthcare organizations to overlook these red flags and unknowingly hire unscrupulous or incompetent providers, endangering patients and leading to lawsuits.

Since no official body exists to track these lawsuits, information on lawsuits or settlements that might otherwise alert an organization to a dangerous provider is not readily available. Most cases are filed with local jurisdictions, and many hospitals settle their own cases.

Verisys can help. With its 24-hour nationwide provider license monitoring services, Verisys can alert your organization if an issue arises with a provider’s license, giving you the information you need to take appropriate action so you can keep your patients and organization safe.

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