How to Apply for Privileges

New Applicants: What You Should Know

If you are a new medical staff applicant, your credentialing coordinator will assist you with the credentialing application process.

Credentialing application steps:

1. Email [email protected] to request an application.
2. Requests are processed in 1-2 business days. After your request has been processed you will receive an e-mail with a link to the application portal where you will login to complete your online application.
3. Complete the application and supporting documents as outlined in the application portal
4. You may check the status of your application by logging into your MDApp portal.

Please Note:

• All applicants must have an active Tennessee state license before an application can be fully processed.
• Individuals practicing Telemedicine must have state licenses for their state of residence as well as for any state in which they may see patients.
• Allow 8 weeks from the time that all documents have been turned in for verification and processing.

Initial Applicant Requirements for Physicians

The following are required elements of the initial application and should all be uploaded to/submitted with the online application. Collecting these items in advance and ensuring a complete application is submitted will improve turnaround times.

• Current licensure (in good standing) to practice medicine, osteopathy, or dentistry in this State
• Adequate education and training
  • Detailed information concerning the applicant’s experience, education (including degree, internship, residency and fellowship information) and qualifications for the requested staff category, including information in satisfaction of the basic qualifications specified in Section 3.2(a).
• Appropriate physical and mental health status
• Professional liability insurance that meets the requirements of these Bylaws *(add $1M/$3M specs)
• DEA registration/controlled substance certificate
  • Required for all physician applicants with the sole exceptions of pathologists and telemedicine-only radiologists
• Any current criminal charges pending against the applicant and any past convictions or pleas.
  • The Physician shall notify the CEO or his designee and the Chief of Staff within seven (7) days of receiving notice of the initiation of any criminal charges, and shall acknowledge the Health System’s right to perform a background check at appointment, reappointment and any interim time when reasonable suspicion has been shown
• Any allegations of civil or criminal fraud pending against any applicant and any past allegations including their resolution and any investigations by any private, federal or state agency concerning participation in any health insurance program, including Medicare or Medicaid.
• A signed Medicare penalty statement
• The applicant will be provided a copy of the Medical Staff Bylaws and, the Rules and Regulations as well as key policies and procedures governing the practice of medicine in the Health System.
  • The applicant agrees that he/she will exhaust the administrative remedies afforded by these Bylaws before resorting to formal legal action, should an adverse ruling be made with respect to his/her staff membership, staff status, and/or clinical privileges.
• Notification of Release and Immunity Provisions
  • Statements notifying the applicant of the scope and extent of authorization, confidentiality, immunity and release provisions
• Professional Sanctions
  • Information as to previously successful or currently pending challenges to, or the voluntary or involuntary relinquishment of, any of the following
    • Membership/fellowship in local, state or national professional organizations
    • Specialty board and ECFMG certifications
    • License to practice any profession in any jurisdiction
    • Drug Enforcement Agency (DEA) number/controlled substance license
    • Medical Staff membership or limitation (voluntary or involuntary), reduction or loss of clinical privileges
    • Physician’s management of patients which may have given rise to investigation by the state medical board
    • Participation in any private, federal or state health insurance program, including Medicare or Medicaid. If any such actions were taken, the particulars thereof shall be obtained before the application is considered complete.
  • The Physician shall have a continuing duty to notify the MEC, in writing through the CEO or designee within seven (7) days of receiving notice of the initiation of any of the above actions against him/her.
• References
  • The names of at least three (3) Physicians (excluding employers, employees or relatives), who have worked with the applicant within the past three (3) years and personally observed his/her professional performance and who are able to provide knowledgeable peer recommendations as to the applicant’s education, relevant training, experience, clinical ability and current competence, ethical character and ability to exercise the clinical privileges requested and to work with others;
• Practice Affiliations
  • The name and address of all other health systems, health care organizations or practice settings with whom the applicant is or has previously been affiliated
• Specific requests stating the staff category and specific clinical privileges for which the applicant wishes to be considered
• Photograph: A recent, wallet sized government issued photograph of the applicant
• Professional Practice Review Data
  • For all new applicants and Physicians requesting new or additional privileges, evidence of the Physician’s professional practice review, volumes and outcomes from organization(s) that currently privilege the applicant.
• Physician Health Program Participation
  • Information concerning any involvement, either voluntary or involuntary in any type of physician evaluation or program, including but not limited to, physical, psychological, or chemical dependency or other such program
• Proof of Immunity and/or Vaccination
• Delineation of Privileges: A completed privilege delineation form
• Current Information: Current mobile phone number and e-mail address.
• Medical Staff Dues: Prepayment of Medical Staff dues is required for processing of an application and must be complete prior to appointment or reappointment to the Medical Staff. However, prepaid Medical Staff dues will be refunded in the event that appointment or reappointment to the Medical Staff is denied.

Allied Health Professional (AHP) Initial Application Requirements

Should all be submitted via the online application.

• Current licensure (in good standing) to practice his/her specialty in this State
• Adequate education and training
  • Detailed information concerning the applicant’s experience, education and qualifications for Allied Health, including information in satisfaction of the basic qualifications specified in Section 3.2(a).
• Appropriate physical and mental health status
• Professional liability insurance that meets the requirements of these Bylaws *(add $1M/$3M specs)
• DEA registration/controlled substance certificate. Current DEA is required for all DEA-eligible AHPs
• Any current criminal charges pending against the applicant and any past convictions or pleas.
  • The AHP shall notify the CEO or his designee and the Chief of Staff within seven (7) days of receiving notice of the initiation of any criminal charges, and shall acknowledge the Health System’s right to perform a background check at appointment, reappointment and any interim time when reasonable suspicion has been shown
• Any allegations of civil or criminal fraud pending against any applicant and any past allegations including their resolution and any investigations by any private, federal or state agency concerning participation in any health insurance program, including Medicare or Medicaid.
• A signed Medicare penalty statement
• The applicant will be provided a copy of the Medical Staff Bylaws and, the Rules and Regulations as well as key policies and procedures governing the practice of medicine in the Health System.
• Notification of Release and Immunity Provisions
  • Statements notifying the applicant of the scope and extent of authorization, confidentiality, immunity and release provisions
• Professional Sanctions:
  • Information as to previously successful or currently pending challenges to, or the voluntary or involuntary relinquishment of, any of the following:
    • Membership/fellowship in local, state or national professional organizations
    • Specialty board and ECFMG certifications
    • License to practice any profession in any jurisdiction
    • Drug Enforcement Agency (DEA) number/controlled substance license
    • AHP staff membership or limitation (voluntary or involuntary), reduction or loss of clinical privileges
    • AHP’s management of patients which may have given rise to investigation by the state medical board
    • Participation in any private, federal or state health insurance program, including Medicare or Medicaid.
  • If any such actions were taken, the particulars thereof shall be obtained before the application is considered complete.
  • The AHP shall have a continuing duty to notify the MEC, in writing through the CEO or designee within seven (7) days of receiving notice of the initiation of any of the above actions against him/her.
• References
  • The names of at least three (3) references (excluding employers, employees or relatives), who have worked with the applicant within the past three (3) years and personally observed his/her professional performance and who are able to provide knowledgeable peer recommendations as to the applicant’s education, relevant training, experience, clinical ability and current competence, ethical character and ability to exercise the clinical privileges requested and to work with others.
• Practice Affiliations
  • The name and address of all other health systems, health care organizations or practice settings with whom the applicant is or has previously been affiliated
• Photograph: A recent, wallet sized government issued photograph of the applicant
• Professional Practice Review Data
  • For all new applicants and AHPs requesting new or additional privileges, evidence of the applicant’ professional practice review, volumes and outcomes from organization(s) that currently privilege the applicant.
• Health Program Participation
  • Information concerning any involvement, either voluntary or involuntary in any type of health professional evaluation or program, including but not limited to, physical, psychological, or chemical dependency or other such program
• Proof of Immunity and/or Vaccination
• Delineation of Privileges: A completed privilege delineation form
• Current Information: Current mobile phone number and e-mail address.
• Medical Staff Dues: not required for AHP applicants as AHPs are not eligible for full Medical Staff privileges.