Each payer has its own timeline for
recredentialing as well as differing requirements for peer review, quality assurance, and prior authorization.
Data must be analyzed at least every 6 months and made available to CMS "upon request" and as part of the CMS process of
recredentialing facilities.
The court held, inter alia, that the trial judge correctly concluded that the plaintiff was required to present expert testimony as to the standard of care in credentialing and
recredentialing as well as testimony that the hospital, in fact, breached the applicable standard of care.
In addition to all of the records listed by CLIA and CAP, JCAHO may want to see professional staff meeting Minutes; records of professional and technical staff training and continuing education; records of safety training; and data used to make recommendations about
recredentialing of professional staff members.
Clinicians also need to know the basis for credentialing and
recredentialing decisions.
The court held, inter alia, that the plaintiffs claims against the hospital for negligent credentialing and
recredentialing were not helthcare liability claims because the hospital's alleged acts or omissions that formed the factual basis for the claims could not be considered medical care or healthcare as defined in the Act.
Godat's actions, (2) the hospital was immune from liability under the Texas Medical Practice Act, (3) the hospital met the applicable standard of care when
recredentialing Dr.
Internal documents may also describe the company's system for tracking authorizations and denials and how this information is used for utilization management, quality management, physician profiling, credentialing and
recredentialing, and financial management.
For example, one plan had purchased software for credentialing and
recredentialing, but was not yet in compliance with much of this standard.
Plan fiduciaries must ascertain whether the provider has adopted a written provider-credentialing program based on specific criteria and whether the provider has adhered to that program without exception unless a reasonable written justification for deviation has been established; and to ensure that the provider has adopted written procedures and a written schedule for
recredentialing providers, has adhered to this
recredentialing schedule and has documented the process.
If adequate information is not available through routine credentialing and
recredentialing processes, the burden should be placed on the practitioner requesting privileges to obtain data from other practice facilities.
