Category: Credentialing Standards

State-by-State Series, Part I: The Outliers – Illinois & New Mexico

State-by-State Series, Part I: The Outliers – Illinois & New Mexico

As an industry-leading  NCQA CVO, CredSimple follows not only NCQA CVO standards, but also follows state-specific guidelines to help keep our customers in compliance with all regulations.  Credentialing guidelines are…

What Does It Take to Become NCQA Certified as a CVO?

What Does It Take to Become NCQA Certified as a CVO?

Whether you are a CVO looking to achieve certification, or a company in need of credentialing who wants to be compliant with NCQA, it’s important to know exactly what it…

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…

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…

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…

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…

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…

NCQA Requirements, Part 5: Ongoing Monitoring

NCQA Requirements, Part 5: Ongoing Monitoring

In this series, we break down what you need to know about credentialing, re-credentialing and delegated credentialing. In prior posts, we covered organizational requirements (CR 1), credentialing committees (CR 2),…