Provider Re-Credentialing
Typically, physicians are re-credentialed every three years. Physicians are required to send updated licensing and other credentialing information to NCPPO and HealthLink. NCPPO and HealthLink verifies the credentialing information.

Standard re-credentialing information includes:

• Re-credentialing report update regarding malpractice cases.
• Current Drug Enforcement Administration (DEA) certificate release forms.
• Current state medical licenses.
• Physician practice information.
• Malpractice coverage summary.
• National Practitioner Data Bank (NPDB) report.
• Board eligibility verification.
• Specialty verification.
• Board certification verification.
• Current state controlled substance certification

All credentialing information obtained by NCPPO and HealthLink from the physician or any other outside source remains confidential. A release from the physician or appropriate court order is required for the release of credentialing information to any third party.

Goal of Credentialing
The main goal of the credentialing program is to support the development and maintenance of credentialing and re-credentialing standards in accordance with URAC requirements; and to ensure enrollees have adequate access to a qualified provider network. The Medical Director of the Credentialing program and Credentialing department management personnel have responsibility for the development, implementation and oversight of the credentialing program. Credentialing policies and procedures are reviewed and approved on an annual basis by the Credentialing Committee; however, policies may be revised as necessary throughout the year. Such periodic changes are approved on an interim basis by the Medical Director and reported monthly to the Credentialing Committee to obtain formal approval.

Credentialing Committee
The Credentialing Committee meets monthly or as often as necessary to ensure the credentialing process is completed in an efficient and timely manner. The Committee is comprised of physician members. Minutes of each Credentialing Committee meeting are recorded and maintained in a confidential and secure manner within the Credentialing department.

Credentialing Department
The Credentialing associates have responsibility for collecting all of the required documentation and preparing and completing all provider files, including but not limited to obtaining primary source verifications of medical/professional license, medical education, residency, hospital privileges, board certification/board eligibility, professional liability policy/history and disciplinary actions (if applicable). Secondary source verifications include obtaining copies of the provider’s medical/professional license, DEA/State Controlled Substance certificates, professional liability coverage certificate and CV/Work History (if applicable). Each provider must also submit a completed, signed and dated Standardized Credentialing Form and Statement of Attestation.

Confidentiality of Credentialing Activities
Any individual engaged in credentialing activities maintains the confidentiality of all information collected and/or presented as part of the credentialing process. All credentialing information received is kept in strictest confidence and maintained in a secure environment. Access to such information is restricted to only those individuals directly involved in achieving the objectives of our credentialing program.