Best Practices   /   October 2019

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 setting up a Credentialing Committee. Either way, we’ve put together a foolproof guide to getting up and running with a Credentialing Committee. For more information on how CredSimple can make the process as easy as possible, please reach out and we’d be happy to set up a time to talk.

Step 1. Understand what a credentialing committee is and what it does. 

As you know, credentialing  is the process through which providers verify the qualifications of licensed healthcare professionals. This includes verifying their education, training, experience, and competency through Primary Source Verification. The final step, however, is to present that information to a Credentialing Committee for review. 

A Credentialing Committee is made up of at least 5 clinicians who meet regularly to review providers in an organization’s network. The committee is charged with deciding the next course of action for medical professionals who have met, or failed to meet, a certain set of previously agreed upon qualifications, such as having a specific type of flag on their record. 

If you’re wondering why this extra process is necessary, it’s simple: the Credentialing Committee is a critical step to ensuring compliance, and the ultimate gatekeeper of patient safety for your organization.  

2. Decide the composition and structure of the Committee, as well as the cadence of meetings. 

A Credentialing Committee is typically made up of no fewer than 5 clinicians, including one chairperson. Typically, Committees meet in person on a monthly basis, though virtual meetings are acceptable. If a Committee chooses to meet virtually for their regular meetings, it’s commonly accepted best practice to hold one in-person meeting each quarter. Committees should never “meet” via email.

You will want to ensure that the members are respected clinicians in their field, as clinical acumen is critical to making good credentialing decisions. Most importantly, it’s critical for members are willing and able to devote time to prepare for and participate in the regular meetings.

3. It’s finally time to draft your Committee members.

As we mentioned above, clinicians who join the Committee should be prominent and well-respected members of their field and practice. To find potential Committee members, you can look at: 

  • Practicing clinicians at prominent healthcare systems and practices
  • Recommendations from peers in your own network, and the network of practitioners you’re familiar with 
  • Members of medical associations

You can reach out to these providers any way you see appropriate: via letter, email, phone, or even LinkedIn. Being a member of a Credentialing Committee is generally seen as a professional accomplishment, so you’ll be able to generate some excitement. 

4. Interview your committee member candidates

You’ll want to make sure that each clinician is the right fit for your organization’s committee. Probe into their background – look not only for clinical expertise, but if they have knowledge of the credentialing process. While this isn’t necessary, it is highly valuable. You’ll also want to understand why they’d like to be on the Committee, what clinical knowledge they can contribute, and if they share your organization’s values.

5. Select your Chairperson.

Understanding the role of the Chairperson will help drive your selection process.  The individual holding this title is responsible for ensuring meetings follow established policies and procedures, and that they are held in an efficient manner. Frequently, you are going to look for someone with strong leadership traits that simultaneously has a  deep understanding of the policies and procedures associated with credentialing.

6. Hold your first meeting.

This first meeting will be a little bit different than the regular meetings. During this meeting, the Committee will review and approve the policies and procedures of your organization. They will also decide the cadence and format of future meetings. 

As you review and approve the policies and procedures, it is key to do the same for the leveling or tiering criteria used to make determinations on each provider brought before the Committee. Determining how you’ll review practitioners is critical to ensuring your future committee meetings run efficiently, your organization remains compliant, and that determinations are derived by adhering to a well-defined policy.

7. You’re ready to begin your regular cadence of Committee meetings.

Schedule your meetings well enough in advance to ensure robust participation. Remember that video-conferencing is sufficient to conduct meetings, but email is not. If you choose to conduct these meetings in person, make sure you security and privacy measures are sufficient to protect confidentiality. During each meeting, members will review providers’ credentials and document reasoning behind all decisions made, as this is required by the NCQA. 

To read more about how to prepare for and run a Committee meeting, check out this blog post, which includes a free template for recording meeting notes.

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Just like that, you have a full Credentialing Committee up and running! 

CredSimple’s Committee services helps ensure your committee meetings are compliant and efficient. Using our tech-enabled solution, we Level/Tier providers, prepare files, and even facilitate meetings. We also provide assistance with the creation of policies and procedures for credentialing and the Credentialing Committee. Let us know if you’d like to learn more about how we can help make Committee as easy as possible. 

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