Licensing and Credentialing

Providers must go through a credentialing process before they are allowed to work. This credentialing process is done at both the hospital/facility level as well as through the various health plans. Most health plans will accept a uniform application although some plans may require additional paperwork. The hospitals and health plans verify medical schooling, residency training, medical references, state licensure, DEA certification, liability insurance coverage, malpractice history, hospital affiliations, practice history, military experience, faculty appointments and the National Practitioner Databank. Verification of this information is through primary sources; therefore, it may take up to three months or longer to complete this process.

Documents for the Credentialing Process

The following documents will be required to begin the credentialing process:

Copy of current medical license
Copy of board certification
National Provider Identifier (NPI) Letter
Copy of your medical school diploma degree
If educated in a foreign country, copy of your ECFMG certificate
Verification of residency program completion

To facilitate the credentialing process, we recommend that you apply for a temporary license. This allows you to obtain the license within 4-6 weeks. You are then able to use your license number to complete your credentialing paperwork so that the credentialing process can start.

Residency Requirement

Within the Minnesota market, third-party payers require physicians to complete residency training. Physicians that have completed only an internship or have not completed their residency training are finding it difficult to get positions because employers will have difficulty in credentialing them for third-party payer reimbursement.

Board Certification

Within Allina, all physicians trained after 1985 must be board certified or become board certified within 24 months of employment. If just completing a residency, the physician must sit for the boards within 24 months, or as defined by the specialty board. Also, health plans are more restrictive regarding specialty areas within which a a provider may work. Most plans require providers to work in the specialty area for which they did their residency training.

Licensing

General requirements for obtaining a license (and applicable fees) are available at the Minnesota Board of Medical Practice and the State of Wisconsin, Department of Regulation and Licensing. If you have questions, please contact the Board directly.