NEW PROVIDER CREDENTIALING CHECKLIST : PHYSICIAN
Welcome ! We want to ensure you have a smooth and engaging onboarding experience . Before you begin your new role with Renown Health , you will complete a comprehensive onboarding process , including several applications for licensure , credentialing , and employment .
Please also review the checklist included in the application for your NV State license to obtain the appropriate documents required by the Board .
Below is a list of required supporting documents for the Renown credentialing application process . We recommend you gather these items as soon as possible to ensure timely processing of your application .
□ CV ( include start and end dates in mm / yyyy format for education and work history )
□ Diplomas ( Medical School , undergraduate , and any other postgraduate education – please note : transcripts cannot be accepted in place of diplomas )
□ Board certification ( s )
□ Internship , Residency , and Fellowship certificates
□ All licensure ( State , Pharmacy , and DEA )
□ Certificates of Insurance ( documentation of malpractice coverage for past 10 years )
□ Case / procedure / activity logs ( Supporting documentation for the requested privileges as outlined in the DOP or SOP . Logs should include : provider and entity name , dates ( covering at least the past 2 years ), CPT codes , and activity / procedure descriptions . Logs must be HIPAA compliant .)
□ PECOS username & password
□ CAQH username & password ( please ensure your CAQH profile is updated )
□ American Heart Association ( AHA ) BLS card
□ AHA ACLS ( only required if you will be requesting moderate sedation privileges )
□ Driver license
□ 1 photo ( plain , white background ; front-facing , from the shoulders , up )
□ TB and Flu Vaccine proof ( within last 12 months )
□ 3 peer references with equivalent licensure ( Please note : it is suggested peer references be informed in advance to expect a request from Renown Health via email )
□ ECFMG certificate ( if applicable )
□ Visa ( if applicable )
□ Military Service DD214 ( if applicable )