Frequently Asked Question

"What is Credentialing and why is it needed?"
- The process for gaining Medical Staff Privileges at UCSF meets federal regulations which enables our healthcare providers to confidently and legitimately provide patient care.
- Healthplan enrollment facilitates patient care revenue generated from contracted healthplans, if a provider isn't an approved provider with the respective healthplans, the department and Medical Center lose the money that should be reimbursed by the healthplans for seeing their patients.

"What is the Credentialing Process at UCSF?"
There are two major steps to the credentialing process at UCSF.
- Obtaining Medical Staff Privileges
- Health Plan Enrollment/Managed Care Enrollment

"How can credentialing be managed on a deparment/division level?"
Visit the 'Credentialing Query' regularly and pull reports on your providers to identify what providers need follow up on healthplan enrollment or a pending recredentialing.

"What are Medical Staff Privileges?"
UCSF Medical Staff Privileges are what allows a healthcare provider to see patients. These are gained by an official request for privileges from a Department Chair and upon confirmation of training, licensing and a background check.

"What is Managed Care/Healthplan Enrollment?"
All UCSF healthcare providers who intend to bill on their own behalf for patient care MUST enroll with all contracted healthplans through the UCSF Medical Group Credentialing. To NOT do so will ensure the loss of revenue on a clinic, department and Medical Center level.

"Who manages the Credentialing process?"
The credentialing process is managed by the UCSF Medical Staff Office and the UCSF Medical Group Credentialing. Any questions can be referred to Credentialing@ucsfmg.ucsf.edu or by calling the credentialing hotline at 415-476-4003.

"How long does the Credentialing process take?"
Providers and departments should ideally submit all credentialing paperwork for a new provider 60-90 days before their anticipated start date. This lead time allows for proper processing and follow-up on any incomplete items, as well as enough time for proper enrollment in all contracted health plans.

"What is the difference between Medical Staff Privileges and Managed Care Credentialing?"
Medical Staff Privileges allows a provider to see patients at UCSF, Healthplan Enrollment is enrolling each provider with the various health plans that UCSF is contracted with.

"When should the Credentialing process start?"
Providers and departments should ideally submit all credentialing paperwork for a new provider 60-90 days before their anticipated start date. This lead time allows for proper processing and follow-up on any incomplete items, as well as enough time for proper enrollment in all contracted health plans.

"Who do I contact if I have questions?"
Any questions can be referred to Credentialing@ucsfmg.ucsf.edu or by calling the credentialing hotline at 415-476-4003.

"How many PIN numbers will I have?"
A UCSF Provider has a minimum of three Personal Identification Numbers. 1) Your UCSF Provider Number 2) Medicare UPIN 3) Medicare PIN

"What is the difference between a UPIN and PIN?"
A Medicare UPIN number is a national identification number which will remain the same no matter where the provider goes, any healthcare provider who has enrolled with Medicare will only have ONE UPIN.
A PIN is a number that links the provider to the healthcare instituition in which they practice. If a provider sees patients at multiple separate institutions, they will have multiple PINs.

"I am already enrolled with Medicare/Medi-Cal in another state or with another healthcare organization why do I need to enroll again?"
All federal and state healthplans require your Medical Staff Privileges be confirmed by the instituition you are practicing at and that you be approved by that federal or state plan to see patients there.

"I have already completed this paperwork at UCSF why do I need to do it again?"
Sometimes, if a provider does not bill for one fiscal quarter (three months) a providers PIN number will be deactivated by Medi-Cal but more commonly Medicare. A red flag of this potentially happening will be if claims are being denied but you have already been assigned a UPIN and PIN for UCSF.

"Who needs to be credentialed?"
Any health care provider working with the UCSF Medical Center, and who is going to see patients.

"How do I get credentialed?"
1) Apply for Medical Staff Privileges
2) Complete Healthplan Enrollment

Forward completed applications and attachments to the UCSF Medical Group Credentialing via intercampus mail to box 1821.