AI Checklist Generator

From the makers of Manifestly Checklists

Email address

Home > Insurance > Provider

Provider

1. Initial Provider Information Collection

Gather basic provider information (name, address, contact details)

Collect full legal name.
Document practice address and mailing address.
Record phone numbers and email addresses.
Include emergency contact information.

Collect relevant license and certification copies

Request copies of state medical licenses.
Obtain copies of specialty board certifications.
Ensure licenses are current and valid.
Check for any additional certifications relevant to the practice.

Request a copy of the provider's malpractice insurance

Ask for a current certificate of malpractice insurance.
Verify coverage limits and effective dates.
Check for any exclusions in the policy.
Request details on claims history, if applicable.

Certainly! Here are some additional steps that could be included in the "1. Initial Provider Information Collection" section

Request a copy of the provider's curriculum vitae (CV) or resume

Ensure the CV includes personal information.
Verify education, training, and employment history.
Request details on research and publications.
Include sections for professional memberships and affiliations.

Collect information on the provider's education and training history

Document all degrees earned, including institutions.
Record dates of graduation and training completion.
Include details on residency and fellowship programs.
Request any additional relevant training certificates.

Obtain a list of the provider's hospital affiliations

Request names and locations of affiliated hospitals.
Document the type of privileges held at each.
Verify the dates of affiliation.
Check for any disciplinary actions at affiliated hospitals.

Gather details on any specialty training or board certifications

Document specifics of specialty training programs.
Verify board certification status and expiration dates.
Include any subspecialties or additional qualifications.
Request proof of ongoing education in specialties.

Request references from previous employers or colleagues

Ask for at least three professional references.
Include names, titles, and contact information.
Request references who can speak to skills and character.
Document the relationship and duration of acquaintance.

Collect information regarding the provider's work history, including previous positions held and duration of employment

Request a detailed employment history.
Document names of previous employers and positions.
Include dates of employment for each position.
Ask for reasons for leaving previous jobs.

Verify the provider's National Provider Identifier (NPI) number

Request the provider's NPI number.
Check the NPI registry for validity.
Document any discrepancies found.
Ensure the NPI is active and unrestricted.

Request a statement regarding the provider's current practice focus or specialties

Ask for a written statement of practice focus.
Document any specific areas of interest.
Include information on patient demographics served.
Request insight into preferred treatment methodologies.

Gather information on the provider's availability and preferred working hours

Request a schedule of available working hours.
Document any preferences for full-time or part-time work.
Ask about flexibility for on-call duties.
Include any preferred days off.

Include a form for the provider to disclose any prior disciplinary actions or malpractice claims

Prepare a disclosure form for the provider.
Request details of any disciplinary actions.
Document any past malpractice claims.
Ensure the form is signed and dated.

Request a signed consent form for background checks and verification processes

Prepare a consent form for background checks.
Include a section for electronic signature.
Document the scope of the background check.
Ensure compliance with privacy laws.

Collect information on any additional languages spoken by the provider

Request details of any languages spoken fluently.
Document proficiency levels (e.g., conversational, fluent).
Include any relevant certifications for language skills.
Ask about experience with diverse patient populations.

2. Credentialing and Verification

Verify provider's education and training credentials

Confirm board certification status

Check for any disciplinary actions or malpractice claims

Here are some additional steps that could be included in the 2. Credentialing and Verification section of the New Provider checklist

Verify state medical or professional licenses and ensure they are active and unrestricted

Conduct a National Practitioner Data Bank (NPDB) query to check for any history of malpractice, adverse actions, or disciplinary history

Review provider's work history and affiliations with other healthcare organizations

Obtain and evaluate references from previous employers or colleagues

Verify any additional certifications or specialized training relevant to the provider's specialty

Assess the provider's continuing education credits and participation in relevant professional development activities

Confirm the provider's National Provider Identifier (NPI) number and ensure it is active

Ensure compliance with any specific credentialing requirements set by insurance payers or regulatory bodies

Review the provider’s personal statement or professional philosophy to ensure alignment with organizational values

Check for any relevant publications or research contributions in the provider's field of expertise

3. Contracting Process

Prepare and send a contract for review

Ensure contract terms are clearly stated (payment rates, services covered)

Obtain necessary signatures and execute the contract

Here are some additional steps that could be included in the "Contracting Process" section of the New Provider checklist

Review and confirm provider’s insurance coverage and liability limits

Verify any required licenses or certifications are included in the contract

Include a termination clause outlining conditions for ending the contract

Establish a timeline for the contract review process

Ensure compliance with any applicable legal and regulatory requirements

Set up a system for tracking contract renewal dates and terms

Discuss and outline the process for amendments to the contract

Schedule a meeting to address any questions or concerns regarding the contract

Collect and store all relevant documentation related to the contract

Confirm the method of payment and invoicing procedures

Outline dispute resolution procedures in the contract

Communicate finalized contract details to relevant internal teams (e.g., billing, operations)

4. System Setup

Input provider information into the claims processing system

Set up billing and payment processes

Ensure the provider is included in the insurance network directories

5. Orientation and Training

Schedule an orientation session for the provider

Provide training on claims submission processes

Review compliance with insurance policies and procedures

6. Ongoing Monitoring and Support

Establish a schedule for regular credentialing updates

Set up a system for addressing provider inquiries and support requests

Monitor performance metrics and feedback from patients and staff

7. Re-credentialing Process

Schedule re-credentialing every 2-3 years as per policy

Collect updated documents and verify ongoing qualifications

Reassess contract terms and performance metrics

8. Compliance and Regulatory Checks

Conduct regular audits for compliance with insurance regulations

Review provider adherence to ethical standards and practices

Stay updated on any changes in laws affecting provider relationships

Download CSV Download JSON Download Markdown

Use in Manifestly

Related Checklists

Cyber Security Checklist

A Cyber Security Checklist is an important tool that helps organizations identify, assess, and mitigate potential cyber security risks.

view →

Financial Audit Checklist

A financial audit checklist is important for ensuring insurance companies are compliant with regulations and accurately managing their finances.

view →

Risk Assessment Checklist

A Risk Assessment Checklist is an important tool for identifying potential risks and developing strategies to mitigate them.

view →

Compliance Checklist

A Compliance Checklist is an important tool to ensure that an insurance company is adhering to all applicable laws, regulations, and best practices.

view →

Billing and Collection Checklist

A Billing and Collection Checklist is essential for ensuring accurate and timely payments from policyholders, helping to maintain a healthy cash flow for the insurance company.

view →

Financial Reporting Checklist

A Financial Reporting Checklist is an important tool used to ensure that all required financial information is accurately reported to the appropriate insurance agencies.

view →

Underwriting Checklist

Underwriting Checklist helps insurers to identify risks and make informed decisions about whether to accept a policyholder's application for insurance coverage.

view →

Customer Service Checklist

A Customer Service Checklist is an essential tool for ensuring that customers receive the highest quality of service and protection from their insurance provider.

view →

Claim Processing Checklist

A Claim Processing Checklist is an important tool to ensure that all necessary information is collected efficiently and accurately, helping to streamline the claims process.

view →

Policy Administration Checklist

The Policy Administration Checklist is an important tool to ensure policies are managed and tracked properly to ensure regulatory compliance and reduce risk.

view →

Renewal Checklist

The Renewal Checklist is a critical part of the insurance process, as it helps to ensure that all policy documents and information are up to date and accurate.

view →

Risk Management Checklist

A Risk Management Checklist is an invaluable tool for helping identify, assess, and mitigate potential risks to an organization's operations and financial health.

view →

Data Security Checklist

A Data Security Checklist is an essential tool to help organizations protect their data and ensure compliance with applicable laws and regulations.

view →

Hey there! Here's a little about us or visit our recurring workflow SaaS: Manifestly Checklists

Light Dark