Credentialing

If your health system or integrated provider network has delegated credentialing arrangements with payers, Managed Care Partners will perform or augment the delegated credentialing functions, including:

• review of the provider’s application and attestation to be certain it is complete,
• original source verification of licensure, board certification, DEA certificate, Medicare/Medicaid participation, education and training, hospital privileges, professional liability insurance, professional liability claims and work history,
• maintenance of performance monitoring and complaints logs,
• monthly checking of sanctions with the state licensing agency and the HHS Office of Inspector General LEIE Exclusions Database, and
• quarterly review of the System for Award Management.

We will also help you keep your delegated credentialing policies and procedures up-to-date and prepare for payers’ on-site or desk audits of your compliance with delegated credentialing agreements.