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Credentialing FAQ'S

1. What is credentialing? 
Credentialing is a term that usually refers to two separate processes: credentialing and privileging. Credentialing is the primary source verification of a health care practitioner's education, training, work experience, license, etc. Privileging is granting approval for an individual to perform a specific procedure or specific set of privileges based on documented competence in the specialty in which privileges are requested.

2. Who is credentialed?
Each licensed individual working in the hospital or clinic setting who are independently responsible for patient care must be credentialed. Licensed independent practitioners who must be credentialed are physicians,dentists, nurse practitioners, physician assistants, psychologists and any other allied health professional

3. How far in advance of my start date should I begin the credentialing process?
Most healthcare organizations advise submitting an application ninety days before a practitioner's start date. Ninety days is a benchmark because it allows extra time when verification sources do not respond in a timely manner or clarification of discrepancies is required.

4. Is there anything a practitioner can do to speed up the application process?
Yes. Practitioners can greatly influence the length of processing time by contacting their verification sources and asking each source to mail or fax verification requests back as soon as possible. It is extremely important for practitioners to submit a complete, clean application.

5. How do I submit a credentialing application?
You can fax, mail, or email your completed application to the LRCVO.

6. What is reappointment?
Reappointment is the process of re-evaluating a practitioner's current information after they have been appointed.

7. Once I'm on staff, why do I need to go through the paperwork again?
The Joint Commission hospital accreditation standards require all practitioners to complete a reappointment process every 24 months.

8. What happens if I don't complete my reappointment paperwork?
If a practitioner does not complete reappointment paperwork on time, the practitioner's reappointment will expire and they can no longer work or see patients. In addition, practitioners will be terminated from all active payors and reimbursement will default to out-of-network benefits.

9. How can I get more information on the reappointment process?
Please call the LRCVO at 318-769-7483.