Credentialing and re-credentialing are critical processes that ensure practitioners practice within the boundaries of their competency and training. According to Fields (2011), the procedures enhance safety for patients. Thus, the National Committee for Quality Assurance (NCQA) standards require all healthcare facilities to put in place clear procedures for credentialing and re-credentialing for the assessment and selection of licensed clinicians (Credentialing Standards. (2018). However, for quality purposes, the process of credentialing and re-credentialing should align with particular criteria.
Thus, from a quality perspective, a healthcare organization should begin the credentialing and re-credentialing processes by making a list of potential physicians. After listing, the center prepares an up-to-date database of the applicants’ contact information. The database will be used to book in with the physician during the entire process. Further, Practice Partners entrusted to conduct the credentialing and re-credentialing process should evaluate and note important information related to applicants’ state licensure information (Shaw, 2015). The assessors should also note the current CVs, work history and education, malpractice liability certificate, and board certification.
Afterward, a thorough background check should be performed. The step involves a comprehensive re-evaluation and double-checking of the information submitted by the physicians for truthfulness and accuracy (Fields, 2011; Shaw, 2015). For example, the staff members should verify the applicant’s employment history and current medical licensure in the state (Shaw, 2015). Equally, all malpractice claims should be investigated by reviewing the clinician’s claim history through the malpractice carrier and the National Practitioner Bank.
Once the verification is completed, the next task is to examine the provider’s personal references to decide whether the physician is fit. Typically, the applying physicians should provide a minimum of three peer references with whom they are not related by marriage or blood. Additionally, the references must be physicians in the same specialty (Fields, 2011).
Finally, the applications should be submitted for review by the governing body. This creates an opportunity for the reviewing and discussion of additional information and any red flags and is reviewed. Under the NCQA’s regulations, providers should be re-credentialed at least once every three years (Credentialing Standards, 2018).
Credentialing Standards. (2018). NCQA Credentialing Standards Part 1: Organizational Requirements. CredSimple. Retrieved from https://www.credsimple.com/general-credentialing/ncqa-credentialing-organizational-requirements/
Fields, R. (2011). 10 Steps to a thorough physician credentialing process. Becker’s ASC Review. Retrieved from https://www.beckersasc.com/asc-accreditation-and-patient-safety/10-steps-to-a-thorough-physician-credentialing-process.html.
Shaw, P. L. (2015). Chapter 14 Developing Staff and Human Resources. In Quality and performance improvement in healthcare. American Health Information Management Association.