Verification of Credentials (#1)

Question 1

Internal Verification

Answer 1

The organization’s staff verifies all information from the primary and approved sources

Question 2

Centralized Verification

Answer 2

One hospital or managed care organization within the system may take on the responsibility of performing all of the verification services for the system.

Question 3

TJC on Delegated Credentialing

Answer 3

• 9 principles to evaluate a delegated agency, including:
  1. Disclosure of data & information available
  2. Processes utilized
  3. Limitations of information available
  4. Identification of primary source information vs. information obtained from a secondary source
  5. Overview of quality control measures related to data integrity, security, transmission accuracy, etc.

Question 4

HFAP on Delegated Credentialing

Answer 4

CVO must meet HFAP standards

Question 5

DNV on Delegated Credentialing

Answer 5

Not specifically addressed

Governing body is legally responsible for telemedicine decisions

Question 6

NCQA on Delegated Credentialing

Answer 6

CVO agreement must contain these 6 elements:

1. Be mutually agreed upon
2. Describe the responsibilities of the organization and the delegated entity
3. Describe the delegated activities
4. Require at least semi0annual reporting to the organization
5. Describe the process by which the organization evaluates the delegated entity’s performance
6. Describe the remedies, including revocation of the delegation, available to the organization if the delegated entity does not fulfill is obligations
   - For Medicare deeming, the delegation agreement must include a statement requiring the delegate to adhere to Medicare regulations

Question 7

URAC on Delegated Credentialing

Answer 7

CVO follows URAC standards; organization performs on-site survey or sampling every 3 years

Question 8

AAAHC on Delegated Credentialing

Answer 8

• CVO is allowed