Credentialing Documents
Attestation Questions
Kickbacks
100

Official document confirming an authorization, for a specific individual to operate one or more types of motorized vehicles. Mostly used as a photo ID for providers.

What is a Driver's license?

100

Improper, illegal, or negligent professional activity or treatment, especially by a medical practitioner, lawyer, or public official.

What is malpractice?

100

Explanation from the provider on what they were doing for a time period greater than six months (after medical school)

What is a gap explanation?

200

An identifier issued by the Drug Enforcement Administration to health care providers and other entities to allow them to work with controlled substances.

What is an DEA license?

200

Open malpractice claim that is still under investigation.

What is a pending claim?

200

Legal contract that the provider and consultant sign.

What is a PSA?

300

A document that identifies a specific malpractice insurance carrier.

What is a Certificate of Insurance?

300

Formal investigation into a complaint made against a licensee by a licensing board.

What is a licensing inquiry?

300

A person who can speak on the provider's behalf regarding their scope of practice or interpersonal skills.

What is a reference?

400
This certificate verifies the qualifications of a physician or by a board of specialists in the field.


What is a board certificate?

400

The action of bringing something to an end.

What is termination?

400

Confidential report that requires reporting of medical malpractice payments and certain adverse actions related to health care providers.

What is an NPDB?

500

Report that verifies a provider's medical licenses including the issue and expiration date and any board actions.

What is an FSMB?

500

A crime that carries a less severe punishment than a felony.

What is a misdemeanor?

500

A document that summarizes the provider's work history and education and must be in month year format.

What is a CV?

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