COVID-19 and Expedited Credentialing ProceduresCredentialing in Privileging and Enrollment
Credentialing is the first of many quality governance procedures that hospitals and health plans implement to mitigate financial and legal risks associated with patient care. Credentialing uses primary-source-verified information to assess a prospective provider’s competence, qualifications, and ability to perform within the scope of his/her specialty. As part of the privileging and health plan enrollment processes, credentialing specialists conduct a variety of verifications and collect extensive data pertaining to the prospective provider’s education and training, professional and malpractice claims history, licensure and board certification status, and peer references. This entails accessing licensing boards, and Federal and State sanction lists, and contacting academic and training institutions. Because this process can take 90–120 days, complications regarding network adequacy and care coverage can be introduced — complications that are substantially compounded during a National Emergency.
To curtail these delays and ensure care coverage, health plans and hospitals have procedures in place in compliance with accrediting body standards to speed up processing times. For most organizations, these procedures have been activated in response to COVID-19.
Privileging During National Emergency
Hospitals across the nation are quickly responding to the National Emergency Declaration by activating Emergency Protocols. In practical terms, this means a reduction of the privileging process down to 72 hours. In contrast to non-emergency application and verification procedures, under Emergency Protocol, hospitals will grant disaster or emergency privileges — these are temporary privileges that will be terminated once the situation is under control — and require:
- Completed Emergency Privilege Form (unique to each hospital); and
- Valid government-issued ID; and
- Evidence of current hospital affiliation from a different facility, e.g., hospital badge with photo; or
- Copy of current license, certificate, or registration to practice; or
- Evidence that provider is affiliated with an Emergency Response team.
This information is then verified within 72 hours by the Medical Staff office using procedures like those for temporary privileging. Disaster privileges are active for the duration of the disaster and are terminated as deemed appropriate by hospital leadership.
For a sample Emergency Credentialing Policy and Privilege Form, please see Baystate Health’s Medical Staff Disaster Credentialing Policy.
Managed Care Enrollment During National Emergency
Managed care organizations have the option of implementing provisional credentialing procedures in compliance with the National Committee for Quality Assurance (NCQA) or Utilization Review Accreditation Commission (URAC) to meet the current demand for healthcare professionals. Like disaster privileging, provisional credentialing allows for faster processing times and increased care coverage. In contrast to normal credentialing procedures, provisional credentialing procedures verify:
- Current, valid license to practice;
- Past five years of malpractice history through malpractice carrier or National Practitioner Data Bank (NPDB is temporarily waiving query fees – for more information: https://www.npdb.hrsa.gov/);
- Current, signed application and attestation
Provisional credentialing can be used on a one-time basis and is valid for only 60 calendar days; managed care organizations must ensure that all providers are fully credentialed, reviewed, and approved within that timeframe. In contrast to NCQA, URAC does not define a time limit for provisional credentialing.
Learn more about TractManager’s Provider Credentialing solution.
For more information from NCQA, please see: https://www.ncqa.org/covid/.
For more information from URAC, please see: https://www.urac.org/press-room/urac-responds-coronavirus.
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