Hospital/Joint Commission Accredited Organization Credentialing Overview

TPQVO clients include hospitals of all sizes--from large urban academic training centers to small rural and specialty hospitals.  The majority of TPQVO clients are accredited by Joint Commission and TPQVO has extensive experience helping clients meet and exceed Joint Commission credentialing requirements.  For a list of TPQVO's hospital verification packet, click here. 

TPQVO meets Joint Commission's requirements for a delegated CVO; we can provide a full white paper explaining how TPQVO complies upon request.

Process Overview

INITIAL APPOINTMENT SYSTEM

Clients may decide whether to delegate application processing to TPQVO or maintain responsibility for distributing and collecting applications to its network member applicants.  TPQVO will work with universal credentialing applications forms, including the CAQH Universal Application form.

TPQVO will request on behalf of the hospital client:

• Current copy(ies) of all valid state licenses

• Current copy of DEA certificate

• CME information for the past 2 years

• Copies of current board and other certifications (CPR, ACLS, PALs, ATLS, NRP)

• Current copy of professional liability “face sheet”

If there are any primary sources that must be queried that charge a query fee, TPQVO will invoice the applicant (or the client if paying on behalf of the applicant) for those fees.

When TPQVO has received a completed application from the client or its medical staff, including requested documentation, TPQVO will forward a copy of the application and materials to the client, if the client does not already have a copy.

TPQVO reviews the completeness and accuracy of the application, including whether all requested documentation is included.  If information is conflicting or missing, TPQVO will contact the applicant and request additional information or clarification.

TPQVO begins the verification process of the following information as required by the client.  Many of the verifications listed are not specifically required by Joint Commission or AAAHC and may be a matter of the client’s bylaw requirements rather than accreditation requirements.

Licensure – all past and present licenses listed on the CV or application are verified by the appropriate state licensing board, including any disciplinary actions taken against the licensee.

Drug Enforcement Administration – TPQVO obtains a copy of the most current DEA certificate from the physician and verifies the certificate through the NTIS website.

Medical/Professional Education – written verification obtained from the medical school registrar where the physician obtained his or her medical degree.

Internship – written verification obtained from the postgraduate medical studies department chairman where the physician completed his or her internship if the internship is listed separately from the residency program.

Residency – written verification obtained from the chairman or chief of service where the physician completed his or her residency program.

ECFMG – foreign medical school graduation and residency verified through the Educational Commission for Foreign Medical Graduates and maintains a copy of the certificate issued by ECFMG.  (TPQVO will attempt to obtain the verification directly from the training facility, but will use the ECFMG as a proxy.)

Fellowship  - written verification from the department chairman or chief of service from which the physician completed his or her fellowship program.

Hospital Staff Positions –  past and present hospital affiliations listed on the application or CV as available (some facilities might be closed and verifications not available).

Practice Affiliations – verify clinical practice positions listed in the application or CV for the past 10 years.  The applicant is required to explain any gap exceeding 30 days occurring after graduation from medical school.

Liability Insurance – Claims histories and coverage (if current) for the past 5 years are verified directly with the malpractice carrier (We can go back to 10 years if a client requirement).

Board Certification – written verification from the Board or its acceptable secondary sources (ABMS, AOA).

Military Service -- written verification of military service and discharge status.

NPDB – National Practitioner Data Bank queries if the client facility is currently registered with the NPDB and has designated TPQVO as its agent for querying purposes.

Peer References – for clients requiring peer references, TPQVO will attempt to obtain references from 3 “peers” as defined by the client.

Additional Checks:

Medicare/Medicaid Sanctions

Government Services Administration Excluded Parties Listing System

Criminal background checks can be added at cost.  TPQVO will work with clients to identify the type and scope of background check to perform. 

TPQVO contacts unresponsive physicians and primary sources a second and third time.  If the physician or source fails to return the needed information, TPQVO will notify the client of its efforts.  Further action will be the applicant’s or client’s responsibility.

REAPPOINTMENT/RECREDENTIALING SYSTEM 

Two Options:

The client maintains responsibility for application distribution.  In this instance, TPQVO sends the application to the client credentialing contact for distribution to the client’s professional staff or client uses its own application.  Client contact will mail, fax or email the completed application and materials to TPQVO for verification processing.

Roster or Work Order.  Client either provides either (a) quarterly rosters indicating the next date for reappointment or (b) provides TPQVO with a list of practitioners needing recredentialing in the next 120 to 180 days.  TPQVO will begin application processing and credentials verification at least 120 days before the recredentialing due date.

Upon receipt of the completed recredentialing form, TPQVO credentialing specialists review the application and documents for completeness and determine whether there is any conflicting or missing information, including requested documentation.  If information is conflicting or missing, TPQVO will contact the applicant and request additional information or clarification.

If there are any primary sources that must be queried that charge a query fee, TPQVO will invoice the applicant (or the client if paying on behalf of the applicant) for those fees.

TPQVO will verify the following information from primary sources:

Medical licenses and any disciplinary sanctions taken against the license(s) will be verified by the state licensing board(s).

Liability insurance – both coverage and claims history for the past two years will be verified by the insurance carrier.

Board Certification

Hospital Affiliation – affiliations for the past two years

NPDB – TPQVO is available to query on behalf of the health care entity if the entity designates TPQVO as its agent.

Any new fellowships or teaching appointments listed on the application or CV.

Peer references – for hospital and surgery center clients; networks and managed care plans if desired.  TPQVO will attempt to obtain references from 3 “peers” as defined by the client healthcare organizations.

Additional checks:

Medicare/Medicaid Sanctions

Government Services Administration – the Excluded Parties Listing System

Criminal background checks can be added at cost.  TPQVO will work with clients to identify the type and scope of background check to perform. 

TPQVO contacts unresponsive physicians and primary sources a second and third time.  If the physician or source fails to return the needed information, TPQVO will notify the client of its efforts.  Further action will be the applicant’s or client’s responsibility.