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  • Dilsa S. Bailey, CPMSM

THE SECRET SIDE OF CREDENTIALING – ORGANIZATIONS



The side of credentialing that doesn’t get any attention is organizational credentialing. At first sight, it looks a lot less complicated than practitioner credentialing. But, is it? There are the basic requirements – licenses in good standing, certification or accreditation, and quality assessments – required by NCQA and CMS. So, what else would you have to do? The answer to that may vary by state, as well as organizational type. What is clear is that every managed care organization that needs to credential a facility should not overlook their due diligence. It is the responsibility of that MCO to make sure the facility meets the accrediting and regulatory agencies’ requirements to deliver health care directly or to support other healthcare delivery services. There must be a set of quality indicators that encompass each type to keep your members safe. Going beyond the basics, and making sure there are no glaring trends of malpractice claims, there are no adverse actions taken by other health care plans against them, and that they do not employ those who can’t accept federal funds. Embedded in other legislative regulations, other than accrediting entities, are criteria to help keep your members safe. Don’t overlook those standards, especially those you may find in the rules overseeing each organization type. My advice is no shortcuts, please.

#organizationalcredentialing #NCQA #CMS #practitionercredentialing #certificationoraccreditation

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