Changing jobs means running two credentialing processes at the same time. The new place verifies your whole career with the primary sources. You also need to close out privileges and payer enrollments at your old job and make sure someone there can answer the new hospital’s questions. Most guides out there cover only the first half, and most are written for residents.

This one’s for those of us already in practice: physicians, and the NPs, PAs, and other clinicians who go through the same process. It covers moving to a new employer and leaving a practice you partly own. Plan on 90 to 180 days for the new hospital’s credentialing and privileging (AMA), longer if you need a license in a new state. If this is your first attending job, start with our guide for graduating residents and fellows instead.

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A delay in one track can hold up the others.

Before you give notice

Confirm you’re in good standing. How you leave can have consequences well beyond this job. If a hospital accepts your surrender of privileges while you’re under investigation, or in exchange for not investigating, it has to report that to the National Practitioner Data Bank (NPDB) (NPDB Guidebook). Whether that applies to you comes down to two questions.

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Routine review means what all of us go through, like ongoing professional practice evaluation (OPPE). If there’s any open case review or peer review referral with your name on it, find out where it stands before you resign. If the answer’s unclear, talk to a lawyer. The mandatory reporting rule covers physicians and dentists, and hospitals can report other clinicians too. Either way, run a free NPDB self-query so you see what the new hospital will see.

Read your contract. Find the notice period, who pays for tail coverage, and any restrictive covenant. Non-compete law varies by state and has shifted in the last few years. Have a lawyer read that clause against your state’s law.

Start the new state license now if you’re moving. Licensing is often the slowest step of the move. If you’re a physician and you qualify, the Interstate Medical Licensure Compact, which most states have joined, is faster. Check your new state’s status on its site.

Pull your own records while you still have access. The new hospital will want recent clinical activity to back up the privileges you request. Export de-identified procedure and activity logs from wherever your specialty keeps them, plus your current privilege list, CME certificates, and a certificate of insurance for every malpractice policy period. Those records can be hard to retrieve once you lose EHR and email access.

List every affiliation. Every hospital, surgery center, and health plan where you’ve held privileges or been credentialed, with dates and the medical staff office’s phone number. The new place will verify each one. A slow reply from a hospital you left years ago can leave your application sitting incomplete.

When you give notice

Line up references from current colleagues. Mid-career applications want peers who’ve seen your recent work, often your current chair or section chief. Ask now, while you still see them every week. Get the email and phone they’ll actually answer after you’re gone, and let them know when to expect the forms.

Resign your privileges in writing, effective your last day. Don’t let them lapse, and don’t resign early. Check your contract first. Some tie privileges to employment, so they end the day the job does. Ask the medical staff office for written confirmation that you left in good standing. The next hospital is going to ask them the same thing.

Settle malpractice coverage before your last day. A claims-made policy only covers claims reported while it’s active. When it ends, you need tail coverage from your current carrier, which often runs a full year’s premium or more and has a deadline to request it (Medical Economics), or prior acts coverage from your new carrier (MICA).

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Your new application will ask for continuous coverage history and a certificate of insurance for every policy period. A gap here shows up in credentialing too.

Applying at the new organization

A mid-career file is bigger than a new grad’s. Each year in practice adds more to verify, which means more people to hear back from.

Expect every affiliation to be checked. The medical staff office will contact each hospital and surgery center on your list to confirm dates and standing. Having the dates and contact information ready helps keep this moving.

Request malpractice loss runs early. Applications ask for your claims history, and verifiers confirm it with each carrier. Ask every carrier you’ve had for a loss run (their claims report on you) the week you sign. Some take weeks to come back.

Explain every gap before anyone asks. Health plans credentialing to National Committee for Quality Assurance (NCQA) standards need an explanation for any gap of six months or more, in writing if it’s over a year (Andros summary of NCQA CR 3). Hospitals often look harder. That includes gaps from a notice period, a non-compete sit-out, or time off between jobs. Write one sentence for each and attach it.

Answer the disclosure questions the same way every time. Your answers on past claims, investigations, and privilege actions get checked against your old applications and the NPDB. If an answer’s complicated, disclose it and attach a short explanation. Don’t leave it for them to find.

Ask about temporary privileges, but don’t count on them. Under Joint Commission standards, a new applicant with a complete, clean application can get temporary privileges for up to 120 days while the file waits for final approval (Joint Commission MS.06.01.13, 2020 edition). Each hospital decides whether to grant them, and billing still waits on payer enrollment.

Expect a focused review after you start. Joint Commission hospitals run a focused professional practice evaluation (FPPE) on all initially requested privileges, even for experienced people new to that hospital. It’s routine. Ask how yours will work so you can plan your schedule around it.

Payer enrollment

Privileges let you see patients in the hospital. Payer enrollment is what lets your new employer get paid for it. It has a separate timeline and often determines your start date.

Your NPI stays with you. Update your record in NPPES, the federal NPI registry, within 30 days of the change. That’s a federal requirement (45 CFR 162.410).

Medicare: get the reassignment filed early. Your new group bills Medicare for you through a reassignment of benefits (Form CMS-855R, or the same step in PECOS, Medicare’s online enrollment system). A reassignment takes effect no earlier than 30 days before it’s submitted (42 CFR 424.522). File it late and your first months can’t be billed under the new group (Figure 4). Make sure the old group ends its reassignment too. Practice location changes have to be reported within 30 days (42 CFR 424.516). If you’re moving to a state with a different Medicare contractor, you may need to enroll with that contractor as well.

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CAQH: update it and re-authorize. Most commercial plans pull your data from CAQH ProView, now run by DataSpring as the Provider Data Portal. Update your practice locations and group affiliation, authorize the new group and its payers to see your profile, and re-attest. Attestation is generally due every 120 days (DataSpring). A lapsed attestation can hold up your commercial applications.

Commercial plans and Medicaid enroll you one at a time. Each plan credentials you under the new group’s tax ID, and every state Medicaid program has its own process. Ask the new employer’s enrollment team for their list and timeline in week one, and turn their signature requests around the same day.

DEA registration if you’re changing states

Your DEA registration is tied to the state where you practice. DEA can only register you there if that state already authorizes you to prescribe controlled substances (DEA registration FAQ). Order matters:

1. Get the new state license.

2. Get the state’s controlled substance registration, if that state requires a separate one.

3. Modify your DEA registration to the new state address, or register there if you’ll keep practicing in both states.

Until step 3 is done, you can’t prescribe controlled substances in the new state. Hospitals often want the DEA certificate in the application, so a late DEA change can hold up the file too. Staying in the same state? You still need to update the address on your registration.

If you’re leaving a private practice or partnership

Everything above still applies. Leaving a practice you partly own adds a few steps.

• Your partnership, operating, or shareholder agreement governs your exit. It usually sets the notice period, how your share gets valued and bought out, and who pays for tail. Read it early and review it with your own lawyer and accountant. The buyout won’t hold up credentialing, but the tail terms usually live in the same agreement.

• Payer contracts belong to the group’s tax ID, not to you. You’ll be enrolled again under the new group’s tax ID, or your own if you’re starting a practice. The old group has to end your reassignments and take you off its rosters.

• Your patients need a plan. They should know how to reach you and how to get their records. AMA ethics guidance says a departing physician must make records available to the succeeding physician and never refuse a patient’s transfer request (AMA Opinion 3.3.1). State law sets the details, including notice and how long records have to be kept.

• You may end up holding the old group’s affiliation records. If the practice is winding down, make sure somebody will still answer verification requests about you and your former partners.

Where people get burned

• Resigning privileges while a case review is still open

• Letting a claims-made policy end with no tail or prior acts coverage in place

• Losing EHR access before exporting activity logs the new hospital will ask for

• Listing references who can’t be reached once you’ve left

• Waiting to apply for the new state license until credentialing starts

• Filing the Medicare reassignment weeks after the start date

• Forgetting that CAQH attestation lapses while you’re busy moving

• Leaving a notice period or sit-out gap on the CV unexplained

Your credentials follow you

Every job change means documenting your career again for people who don’t know you. I go through it too, every time I’m credentialed or reappointed somewhere. Having your records ready before you leave makes the next application easier.

That’s why we built SynAIpse Safe: a free, physician-owned home for your credentials. Keep everything in one place, under your control, and take it with you to the next job. Create your SynAIpse Safe.

Questions or corrections? Contact us.