Health Plan (7.4) 7.4

P-CR 8 - Credentialing Communication Mechanisms

Submited by: Tom Goddard

The Basics

This standard carries two requirements. First, your organization must have mechanisms by which it communicates with providers about the credentialing status, upon request. Second, your organization must be willing and able to accept additional information from providers that they submit in order to correct incomplete, inaccurate, or conflicting credentialing information.
Note that this standard does not say that your credentialing committee cannot take conflicting information into account; only that it must allow the provider to submit information to try to clear up inconsistent information. If, after receiving such information, your credentialing committee is still concerned about the truthfulness of the information, it may act on that concern.

Management Tips

Often, organizations address the standard by sending providers cover letters that offer the provider information about how to contact your organization in the midst of the credentialing process to find out more information, including current status of the application.
Be sure your staff is well-trained on how to allow the provider to correct incomplete, inaccurate, or conflicting information in his/her file.

Accreditation Tips

Desktop Review
During the desktop review phase, you should submit your credentialing plan, which must include a description of how he organization responds to requests from providers about whether application is in the credentialing process.
Validation Review
Members of the credentialing staff will be interviewed to see if they understand the organization's policies and procedures about responding to provide a request for information about the credentialing process.
Document Review
As is the case with many of the credentialing standards, most of the effort to assure compliance with this will be conducted during the review of three dozen credentialing files. 

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