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Read the instructions under 11D in the workbook and also go to the Appendix. In the Appendix under “Forms” note there is a sample credentialing packet for a managed care company. Follow the instructions and create a cover page with information you make up about the physician and the practice. Then, list the name of each attachment followed by a description and submit to this drop box. You are allowed to make up all of the information (name, CMEs, etc) and you don’t need to include addresses/phone numbers. Example:

Your submission should include:

Cover page (make-up the information for the doctor and practice).

A list of attachments with descriptions. For example:

The typical credentialing packet has 10 attachments. The most common of these and their purpose are:

1: Physician’s CV. Contains a summary of the physician’s academic and professional work history including any articles he or she published, any presentations he or she made, any research and also a summary of all major CMEs (Continuing Medical Education Hours). The CV provides the credentialing committee with a snapshot of the physician’s education, experience, specializations, licenses, applicable board certification and how they stay current. Even though other attachments provide more detail such as an attachment of CMEs, this overview forms a frame of reference for the committee members to proceed



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