Category: Credentialing Standards

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 3 ways to mind how it affects your business: #1 — The Accuracy and Usefulness of Your Provider Data Networks and providers are constantly changing. […]

Provider credentialing is a necessary business function for health plans and is required in order to ensure quality of care for members. When implementing — or reevaluating —  a credentialing process, there are a few important factors to consider such as cost, employee time and even whether to adhere to NCQA or URAC standards. A […]

In this series, we break down what you need to know about NCQA’s credentialing requirements. Here we’ll cover NCQA credentialing requirements 4 – 8, which ensure that credentialing committees are reviewing all the necessary information about a provider’s credentials and work history so that the committee can make a well-informed decision. In prior posts, we […]

NCQA CR 9 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), the establishment of credentialing requirements (CR 3) and information that the credentialing committee needs to review (CR 4 – 8). In today’s post, we will cover […]

behavioral health

There have been several new pieces of legislation passed in New York State that are changing the healthcare regulations. New York’s new regulations—Medicaid Carve-In and Article 31—require behavioral health programs to credential providers differently and to a higher standard than ever before. Before you start wondering how your already-overloaded credentialing team will carry an even […]

Credentialing Requirments

In this series, we break down what you need to know about credentialing, re-credentialing and delegated credentialing. In today’s post, we cover the establishment of credentialing requirements (CR 3). In prior posts, we covered organizational requirements (CR 1) and credentialing committees (CR 2). But before we dive into the nitty-gritty of today’s installment, remember that […]

NCQA CR2

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 prior post, we covered organizational requirements (CR 1), and in future posts we’ll cover credentialing requirements (CR 3 through CR 8) and delegation of credentialing […]

NCQA Certified CVO

CredSimple is now an NCQA Certified CVO NEW YORK, March 1, 2016 /PRNewswire/ — CredSimple, the leading SaaS platform for real-time credentialing of medical providers and facilities, today announced that it has received its Credentials Verification Organization (CVO) certification from NCQA, a private, non-profit organization dedicated to improving healthcare quality. As a certified CVO, CredSimple has […]

NCQA Credentialing 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 the NCQA credentialing guidelines but don’t have time to wade through 100 pages of regulations. In this series, we’ll break down what you need to […]

Centralized_Credentialing

Centralized credentialing can help eliminate repetitive work, improve revenue cycle, and lower credentialing costs for hospitals, facilities and practices. It also improves provider data integrity and facilitates delegation with payers. To take a deeper dive into the benefits of centralized credentialing, let’s take a moment to understand what centralizing means and what tasks should and […]