Get CREDENTIALS POLICY - Catholic Health Partners

During hospital credentialing, the hospital requests information from the provider about the provider's education, work experience, licensure, medical training, insurance, and background. It then verifies that the provider's credentials are accurate, genuine, current, and in good standing.

“the collection, verification, and • assessment of information regarding • three critical parameters, current • licensure; education and relevant • training; and experience, ability, and • current competence to perform the • requested privilege(s).” Page 4 • Privileging is the process used to identify, document, and ...

The most important physician credentialing checklist of information is as follows: Educational history and transcripts. Current medical license, DEA registration, and board certification. Work history. Evidence of continual malpractice coverage.

There's a lot of confusion surrounding the difference between credentialing and privileging. Credentialing is like asking your chef to show you his culinary school diploma; privileging is asking him to julienne a carrot. Both are important to make sure you have a qualified and skilled person preparing your food.

Identify the Required Documents. As you begin the provider credentialing process, be aware that each insurance company requires different documentation and forms. ... Prioritize Insurance Companies. ... Check for Accurate Information. ... Completing the CAQH. ... Wait for Verification. ... Following Up. ... Recertification.

It's a time-consuming process. You must first collect the required documentation — from current hospital privileges to a valid state license to confirmation of medical malpractice insurance. Then you must wait 30 days to a year for the MCOs to verify the documentation before the physician can be added to their panels.

Privileging refers to giving an individual permission or 'privileges' to engage in specified clinical activities. ABC defines how a credentialed person may be allowed, under supervision, to provide items and services outside of their scope of practice.

Credentialing is "the process of assessing and confirming the license or certification, education, training, and other qualifications or a licensed or certified healthcare practitioner." Privileging is "the process of authorizing a health care practitioner's specific scope and content of patient care services."