Credentialing is more than a “check the box” regulatory burden, it is an essential safety component of health care. NCQA Credentialing Accreditation can help your organization improve its credentialing/recredentialing processes—and our newest eBook, A Comprehensive Guide to NCQA Credentialing Programs, contains the information you need to begin.
CREDENTIALING ACCREDITATION
Credentialing organizations provide the full scope of credentialing services covered in the standards and guidelines, including:
- Initial verification of practitioners’ credentials through a primary source, through a recognized source or through a contracted agent of the primary source.
- A designated Credentialing Committee that reviews practitioner credentials and makes recommendations based on established criteria.
- Monthly monitoring practitioner sanctions, license expiration, complaints and quality issues between recredentialing cycles.
- Takes action.
Organizations have the opportunity to demonstrate the quality of their programs to employers, regulatory agencies and health plans, many of which may insist on NCQA Accreditation. For NCQA-Accredited Credentialing organizations contracting with organizations that have (or are seeking) NCQA Accreditation, the Accreditation process is facilitated with automatic credit for certain activities performed by the organization, which can significantly reduce requirements for oversight, minimizing the burden for all parties.
CREDENTIALING CERTIFICATION
Credentialing Verification Organizations (CVOs) verify practitioners’ credentials—their academic, licensing and clinical practice history—through a primary source, through a recognized source or through a contracted agent of the primary source. They then report the information to their clients. CVOs have systems in place to protect the confidentiality and integrity of the credentialing information they collect, and have a process for updating the information when appropriate. The NCQA CVO to Credentialing program evaluates verification operations and the processes CVOs use to continuously improve services provided to clients.
The NCQA Credentialing Certification program offers the following 11 credentialing evaluation products. All are required for NCQA-Accredited health plans, behavioral healthcare organizations (BHO) and for organizations with NCQA Accreditation in Credentialing, which are typically CVO clients.