A health plan must designate a credentialing committee that uses a peer review process to make credentialing and recredentialing decisions. Members of the committee must include participating practitioners who can review and provide input on applicants for initial credentialing and...

CMS and The Joint Commission require individuals other than licensed physicians who provide a “medical level of care” in the hospital to be credentialed and privileged in the same fashion as physicians. As advanced practice professionals (APP) have a greater presence in medical centers, some...

By Kathy Matzka, CPMSM, CPCS

Clinicians are often unaware of the detailed steps of the credentialing process and are too embarrassed to ask. Now they have a go-to guide for credentialing, privileging, applying for medical licensure, verifications, and other sometimes-confusing...

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