Glen Newman, MD, Chairman, Chattanooga and Hamilton County Medical Society

Mark Worthington, MD, Chattanooga and Hamilton County Medical Society

Rae Bond, Chattanooga and Hamilton County Medical Society

Rob Page, MD, Knoxville Academy of Medicine

Kim Weaver, Knoxville Academy of Medicine

Yarnell Beatty, JD, Secretary-Treasurer, Tennessee Medical Association

John McCarley, MD, Tennessee Medical Association

Currently, TPQVO maintains approximately 8,000 physician, dentist, and other healthcare provider credentials files.  The vast majority of practitioners maintained in TPQVO files are physicians (MDs/DOs).   These files are processed for initial credentialing and recredentialing for over 70 hospital, health care network, clinic, surgery center, federally qualified community health centers, public health service, and home health clients throughout the U.S.

TPQVO follows the credentials verification standards set by the National Committee on Quality Assurance (NCQA) for managed care organizations, the Joint Commission for hospitals and surgery centers, and Accreditation Association for Ambulatory Health Care (AAAHC) for surgery centers.  Some hospitals define higher credentials verification standards through medical staff bylaws than those required by Joint Commission.   TPQVO will work with those clients to meet the higher standards whenever possible.

In addition to application processing and primary source verification, TPQVO monitors expiring documents and licenses (DEA registration, insurance certificate, licenses) and obtains new documentation from providers.  This document update service is provided for no additional cost to clients using TPQVO for processing recredentialing information.  Also, TPQVO monitors the HHS Office of Inspector General Medicare/Medicaid sanction reports and state licensing board disciplinary actions and notifies clients of any adverse information regarding practitioners on their current rosters.

TPQVO operates under extensive policies and procedures specifying the credentials verification process, primary sources queried, record confidentiality, security of paper and electronic records, quality improvement and other organizational functions and structure.   Excerpts from the Policy and Procedure are available upon request.

Additionally, TPQVO develops and implements annually a Quality Improvement Plan.  Results from continuous performance measurement are described below.

As part of its quality improvement program, TPQVO tracks the time it takes to complete credentials verifications.  The data tracked from TPQVO’s inception in 1998 through 2015 show only a small percentage of verifications exceeded TPQVO’s benchmark of 90 days for appointments and 60 days for reappointments.  

Turnaround times for processing initial application and recredentialing applications for 2015 reflect the vast majority of files were processed using Joint Commission standards plus additional elements required by individual clients.  Average processing times for initial applications were 45 calendar days for physicians and 43 calendar days for allied health practitioners.  Recredentialing times averaged 40 days for physicians and 46 days for allied health practitioners.  Average times for NCQA standards were one business day of TPQVO receipt of the completed application.

Verifications are complete only when primary source verifications are obtained or there are three attempts to verify the information.  (In those cases, secondary sources acceptable to NCQA and files closed as “incomplete” are not included in the data displayed above.  Clients are notified of all missing documents or information that could not be verified.  Joint Commission standards will be used or clients are notified of outstanding verifications.)  Signatures on attestations are checked to make sure they are current to maintain overall timeliness of file processing.  If a signature is outdated, TPQVO will obtain an updated signature from the applicant to maintain the 120-day wrap around the application and verifications.  Even if an application attestation is refreshed in this way, total days are tracked from the receipt of the completed application.