Category: Credentialing Standards

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),…

What You Need to Know about NCQA Credentialing Requirements 4 – 8

What You Need to Know about NCQA Credentialing Requirements 4 – 8

In this series, we break down what you need to know about NCQA’s credentialing requirements. Below we cover NCQA credentialing requirements 4 - 8, which ensure that credentialing committees are…

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,…

What You Need to Know about NCQA CR 2: Credentialing Committee

What You Need to Know about NCQA CR 2: Credentialing Committee

In this series, we break down what you need to know about credentialing, recredentialing and delegated credentialing. In today’s post, we cover the establishment of a credentialing committee (CR 2). In a…

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…

Expiring Malpractice Insurance: What’s That Rule Again?

Expiring Malpractice Insurance: What’s That Rule Again?

The time between when a provider signs their attestation and when the provider’s file goes to committee for review can often mean that dates, such as malpractice insurance expiration, have…

3 Costly Ways Your Credentialing Operation Affects Your Bottom Line

3 Costly Ways Your Credentialing Operation Affects Your Bottom Line

Your provider credentialing process directly affects your organization’s bottom line in numerous ways. It’s worth considering now whether your credentialing function is a headwind or a tailwind on revenue. Here are…