Certified Provider Credentialing Specialist (CPCS)
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NCQA time limits on professional liability /malpractice for HP/MBHO - ✔✔The credentials
information must be valid, current, and no more than 365 calendar days old at the time of the
credentialing
NCQA time limits on professional liability /malpractice for CVO - ✔✔The credentials
information must be valid, current, and verified within 305 calendar days prior to submission to
each client.
Verification of professional liability/ malpractice coverage according to CMS - ✔✔PSV is not
required, the requirement for professional liability coverage is common in healthcare , thus
verification of coverage is appropriate.
Verification of malpractice history according to TJC. - ✔✔The standards are silent regarding
the specific method to accomplish this requirement , but it is suggested that the organized
medical staff evaluate any evidence of unusual pattern or excessive numbers of professional
liability actions resulting in a final judgment.
Verification of malpractice history according to NCQA - ✔✔The applicant must provide at
least a five-year history of malpractice settlements or judgments. This information is to be
verified either through written comfirmation from the Malpractice carrier or through the NPDB.
NCQA malpractice verification time limits for HP/ MBHO - ✔✔180 days
NCQA malpractice verification time limits for CVO - ✔✔120 days
, Verification of malpractice history according to CMS - ✔✔CMS is silent regarding evaluation
of malpractice history, however CMS does require organizations to be compliant with state and
federal law.
Verification of work history according to TJC - ✔✔TJC does not use the term "work history".
But does require evidence of current competence. Require that applicants provide a
chronological history of education, training and experience.
Verification of work history according to NCQA - ✔✔The applicant must provide a minimum
of a five -year relevant work history statement on either the application or CV, which allows
identification of gaps.
Verification of work history according to CMS - ✔✔CMS does not use the term "work
history". But does require evidence of current competence. Require that applicants provide a
chronological history of education, training and experience.
Certified Provider Credentialing Specialist - ✔✔The Certified Provider Credentialing Specialist
(CPCS) is typically employed or contracted by a healthcare organization including, but not
limited to, hospitals (health systems), health plans, ambulatory care settings, group practices,
and credentialing verification organizations.
Initial Appointment / Clinical privileges/ practioners covered according to the TJC - ✔✔All
licensed Independent practitioners must be credentialed and privileged through the organized
Medical staff structure
Initial Appointment / Clinical privileges/ practioners covered according to the NCQA -
✔✔HP's and MBHO's must have documented Credentialing policies and procedures that
apply to all practitioners who provide care to the organizations members
Initial Appointment / Clinical privileges/ practioners covered according to CMS - ✔✔The
Governing body determines, in accordance with Staye Law, which categories of practitioners
are eligible for appointment to the medical staff. At a minimum the medical staff must be
composed of MD 's and DO's.
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