Category: Credentialing How Tos

Breaking It Down: What is credentialing?

Breaking It Down: What is credentialing?

  1.What is Managed Care/Health Plan Credentialing? Credentialing is the process of obtaining, verifying and assessing the qualifications of a practitioner/provider to provide care or services in or for a…

7 Steps to Get Your Credentialing Committee Up & Running

7 Steps to Get Your Credentialing Committee Up & Running

Perhaps you're part of a team helping to start up a new health plan, or maybe you're new to your role and wondering where to start with the task of…

Peer Review Committee Q&A – What You Need to Know

Peer Review Committee Q&A – What You Need to Know

The goal of the Peer Review Committee (PRC) is to ensure an objective review of care and conduct performed by other practitioners, in order to enhance the quality of patient…

3 Things to Know About a Typical Credentialing Committee

3 Things to Know About a Typical Credentialing Committee

What is a credentialing committee, and what is it comprised of? A Credentialing Committee is a body of practitioners responsible for 1) accepting and denying providers into a plan’s provider…

A Quick Download on Reporting to NPDB

A Quick Download on Reporting to NPDB

Reporting to NPDB can be confusing - between knowing what to report, when to report it, and who is responsible for reporting, there is a lot to know. NCQA requires…

Recredentialing Q&A – What You Need To Know

Recredentialing Q&A – What You Need To Know

Q: How often are practitioners recredentialed? A: Practitioners and facilities are typically recredentialed every three years unless a state or health plan has different requirements. It is important to recredential…

The Journey to Achieving Delegated Credentialing

The Journey to Achieving Delegated Credentialing

Have you been thinking about applying for delegated credentialing? Not sure where to start? Going through the process of achieving delegated credentialing might seem like a huge undertaking, but with…

Breaking It Down: Understanding NCQA and CMS Requirements

Breaking It Down: Understanding NCQA and CMS Requirements

CMS vs. NCQA Requirements When it comes to credentialing and compliance, there’s a lot to keep in mind. One of the most fundamental issues is this: what compliance standards are…

Best Practices for Credentialing Committee Meeting Management

As you probably already know, NCQA requires health plans to meet periodically to make credentialing decisions about network practitioners. During this process, known as a committee meeting, outside experts will…

What You Need Know: NCQA Requirements, Part 3: Credentialing Requirements

What You Need Know: NCQA Requirements, Part 3: Credentialing Requirements

In this series, we break down what you need to know about credentialing, re-credentialing and delegated credentialing. Here we cover the establishment of credentialing requirements (CR 3). In prior posts,…