Medical credentials are a market-driven process which seeks to maintain quality standards for the health of patients in the medical community.
The procedure includes direct interaction with original data to verify the qualifications of a healthcare provider. In order to confirm your credentials, the credential authority, called a credentials verification organization or CVO, will consult the university where the provider has received a doctorate in medicine.
They will also contact certification boards, licensing agencies to verify specialized certificates and licenses. The history of work can be confirmed by hospitals and other employers. Credentials are important for new employers, but even after recruiting to comply with regulatory and accrediting standards, including the Joint Commission (TJC), the Centers for Medicare & Medicaid Services (CMS) and the National Quality Assurance Committee, they take place at regular intervals (NCQA).
Q1: What steps must be taken to complete credentialing?
(1) You must complete the application completely. If you do not complete the application entirely or if additional information is required, a representative from the House of Outsourcing will contact you. It is critical that you respond to those requests as soon as possible, or we will be unable to process your application.
(2) House of Outsourcing cross-checks specific data points with the “primary source.” That includes the state licensing board, your professional training/education, and so on.
(3) Once the source verification is complete, your application is presented to a committee of your peers, who will decide whether or not you meet our requirements.
(4) If your application is approved, you will end up receiving a welcome packet and guidelines in the mail.
Q2: How long will it take for my application to be processed?
House Of Outsourcing aims to complete credentialing applications in 60 days or less. This could take longer if you submit an incomplete application or do not include requested attachments with your application.
Q3: How frequently do providers need to be re-credentialed?
Providers must renew their credentialing every three years, beginning with the date of their initial credentialing (unless their state has other requirements). To remain a participating provider, a provider must successfully pass re-credentialing.
Q4: What happens during the re-credentialing process?
After about two and a half years in the network, you will be notified for re-credentialing. Your specialty-specific instructions will be included in the notification. You may not even need to take any action at the time of re-credentialing if your application is on CAQH and is kept up to date.
Q5: What if the Credentialing Committee rejects either my initial participation application or my re-credentialing application?
Depending on the reasons for the committee’s decision, you may be given the option to provide additional information and file an appeal. Your denial or termination letter will explain your rights as well as the timelines you must adhere to.
Q6: Can I submit a state application in the state where I practice?
True. House of Outsourcing follows all of the state-mandated application guidelines.
Q7: What exactly is a National Provider Identification Number (NPI), and where can I get one?
NPI stands for National Provider Identification (NPI). If you are unsure how to obtain an NPI, you should contact your state licensing board to learn more.
Q8: What exactly is a CV, and is it required?
CV stands for curriculum vitae. It’s similar to a resume in that it includes a summary of your educational background, work history, professional license, and any other special training you’ve received. You are not required to submit a CV to the House of Outsourcing. Instead, fill out the application questions.
Q9: My credentialing application was denied due to a lack of information, according to a letter I received. What should I do?
You must follow the instructions provided. If you have any questions, please contact the person who made the request. Respond to these requests as soon as possible so that House of Outsourcing can continue processing your application.
Q10: Why do I have to send you the same information for re-credentialing every time?
House of outsourcing will obtain the information from CAQH if you have a CAQH application and have kept it up to date. You must submit a CAQH application if you have not already done so. After you have completed the application, you must keep the records up to date. In addition, if your clinic is accredited as an organization, you must submit a separate “group” credentialing application.
Q11: I'm not sure why I was rejected (or terminated) access to the network?
The letter you received should have a name and a phone number where you can get more information.
Q: 12 Can I challenge this decision?
Yes, you can use it in most cases. The letter you received should have included instructions on how to file a written appeal.