CPMSM|2023 LATEST UPDATE|GUARANTEED SUCCESS

HFAP Refers to a CVO as a Professional Credentialing Organization (PCO) HFAP Appointment time frame 2 years TJC Appointment time frame No longer than every 2 years NCQA Appointment time frame 3 years (to the month) URAC Appointment time frame 3 years AAAHC Appointment time frame 3 years Attestation Statement TJC and Medicare do not specifically address, URAC allows electronic signature, all others require. Board Certification Verification Not specifically required (only highest level of education) has to be verified within 180 days per NCQA or 120 days if CVO is verifying. CME HFAP may request every 2 years. TJC requires documentation. No others require. TJC views of Competence Monitoring of provider competence must be ongoing. URAC and NCQA views of Competence Monitoring of provider competence must be ongoing and organization must have policies for monitoring in place. HFAP view of Competence Competence can be monitored by proof of procedures performed. This can be done by the provider providing their procedure logs. AAAHC view of Competence Competence can be monitored by provided documentation of competency. Medicare view of Competence Governing body must verify character, competence, judgement, education, and training. Felony Conviction Only addressed by a question or statement of provider application by NCAQ, HFAP, and AAAHC NCQA and URAC on Education Only highest level of education verified. TJC and Medicare Does no address Medicare and Medicaid sanctions. NPDB NCQA and URAC do not require it but it is an acceptable verification of sanctions. All other organizations require. Site Visit NCQA is the only organization that requires a site visit under certain circumstances. Temporary Privileges AAAHC and Medicare do not specifically address. Temporary Privileges granting requirements This type of privilege can be granted by the CEO upon recommendation from the Chief of Staff or authorized designee as long as license, malpractice coverage, and NPDB have been verified. NCQA specifically says Provisional (Temporary) Privileges Can be granted by Chief Medical Official as long as their is a policy in place, the application is clean, and the privileges can be granted for no more than 60 days. Work History URAC and Medicare do not address, NCAQ: History must be verified and any gaps of 6 months or greater require explanation. TJC & HFAP Work History require the question to be asked: Has the provider ever been terminated or suspended and NPDB must be compared to answer of the above question. AAAHC Work History Any interruptions in employment must be accounted for. Health Status Form All organizations require a current statement of ability to perform as a provider. HFAP requires it to be documented from references. Views on Allied Health Professionals NCQA: Credentials all providers the same URAC: Adds that they must be listed in directory TJC & AAAHC: Say that MCO must distinguish providers as those with and without the need for supervision Medicare: Can grant privileges with or without Medical Staff rights. Disaster Plan TJC, HFAP, AAAHC require groups/organizations to have the plan documented and in place. DEA Verification Copies can be accepted, ensure there are no challenges to the certificate. Licensure Medicare: does not specifically address sanctions URAC: states that it has to be verified in a 6 month time frame. NCQA: Verified within 180 days (or 120 for CVO) All organizations require that the monitoring of licensure be ongoing. Malpractice AAAHC, TJC, Medicare: Not fully addressed but states if bylaws require verification or proof of coverage, documentation must be obtained. All other organizations require proof and verification. Malpractice History NCQA: Pulled and verified with in the correct time frames (180 days or 120 days if CVO) URAC: 6 month time frame All require at minimum to verify history for the last 5 years.