What Are “Red Flags” On Medical Credentialing Applications?
A red flag identifies any discrepancy, derogatory information, or potential concerns about an
applicant.
What are a few examples of red flags?
1. Unexplained time gaps in work history, practice, or training.
2. Disciplinary actions by medical staff organizations, hospitals, state medical boards, or professional societies.
3. Derogatory comments.
4. Involuntary termination of appointment and privileges.
5. Unable to verify coverage from a professional liability insurance policy.
6. Any claims or investigations of fraud, abuse, or misconduct from professional or government organizations.
7. No response to a reference request from a prior affiliation.
Once red flags are identified, what happens next?
The Medical Staff Professional (MSP) thoroughly reviews the applicant’s file, identifies the red flag, and understands it is essential to analyze and document the potential concerns justifying further evaluation by the Medical Staff. The Medical Staff carefully reviews the highlighted problems and addresses them according to current policies and procedures.
What is the purpose of red flags?
The objective is to detect deficiencies that would deter a hospital from granting privileges for fears of patient safety and lawsuits. The Medical Staff makes their recommendation by performing a comprehensive review of a practitioner file. Red flags allude to potential professional incompetence or other problem that would deter a health system from granting the provider privileges.
Medical Provider Resources has been a credentialing company for over 15 years. We take pride in providing superior physician credentialing, insurance credentialing, and insurance enrollment services. Our thorough physician background checks, primary source verification, and insurance credentialing ensures that our experts spot red flags immediately to ensure the best in patient care. If you have questions or would like to schedule a free consultation, please call MPR at 316-683-0178 or contact us online and we’d be happy to help!
