Category: General Credentialing

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…

Behavioral Health & Telehealth: A Trend On The Rise

Behavioral Health & Telehealth: A Trend On The Rise

The rise of telehealth in the last few years has been one of many factors re-shaping the healthcare landscape, and there is no place it has had more of an…

The CMS Preclusion List: What you need to know

The CMS Preclusion List: What you need to know

By now, we're sure you've heard about - or have already been impacted by - CMS' new list of preclusions, which will disqualify some prescribers and providers from receiving payment…

The ABCs of PSVs

The ABCs of PSVs

Have you ever found yourself asking primary source verification (PSV) questions like: "Which verifications need to be checked to ensure a provider is properly credentialed to work at your ambulatory…

NCQA Credentialing Standards Part 1: Organizational Requirements

NCQA Credentialing Standards Part 1: Organizational Requirements

One of our goals for our blog is to demystify credentialing so we are creating a series especially for leaders and business process owners who want to gain a deeper understanding of…

When Your CVO is a Trusted Partner

When Your CVO is a Trusted Partner

Not all CVOs are created equal. When considering moving your credentialing function to a CVO or switching CVOs, it’s worth asking: What do I need from this relationship? What is…

The Next Frontier of Healthcare Business Process Outsourcing

The Next Frontier of Healthcare Business Process Outsourcing

Outsourcing within the healthcare industry is already the norm, but the processes that organizations are willing to outsource is shifting. MarketsandMarkets projects that healthcare’s business process outsourcing (BPO) market will…

How HIT Is Improving Administrative Efficiency

How HIT Is Improving Administrative Efficiency

In recent years, technology has transformed the patient side of healthcare with advances such as Electronic Medical Records. Even though healthcare accounts for more than a sixth of the economy,…