The Credentialing Chronicles
What is the primary purpose of credentialing?
verifying a provider's qualifications and eligibility
What is one common reason a provider may be terminated from the ASH network?
What is an expired license?
What does CAQH stand for?
What is Council for Affordable Quality Healthcare
A provider receives a recredentialing request but has a CAQH number on file. What are they typically asked to do?
What is re-attest on CAQH?
A provider's application has been received and is currently being worked on by credentialing. What is the status called?
What is In Credentialing?
Name 3 item that is typically verified during credentialing.
What is a medical license, education, or sanctions history
If a provider is terminated for failing to renew their license, when does the termination become effective?
What is immediately?
What does a Green Status indicate in CAQH?
What is the provider is ready and attested?
What status means ASH has sent three notifications and the provider has not responded?
What is Recred App Not Returned?
A PSCR was submitted more than 30 days ago and still does not appear in PROMIS. Who should the case be escalated to?
What is CRD Assist?
True or False: Credentialing is usually completed before a provider joins a network.
True?
After a license-related termination, how many days does a provider have to update their license and potentially be reinstated?
What is 30 days?
What unique identifier does a provider receive after creating a CAQH account?
What is a CAQH ID?
Before a termination can be reversed, what is the first thing you should confirm?
What is that the provider is still within their appeal date?
A provider says they have called and emailed their Credentials Examiner several times but have not received a response. Who should you contact first?
What is the assigned Credentials Examiner?
What document confirms that a provider has been approved and added to the network?
Welcome Letter
A provider updates their license after termination. What should Provider Relations do next?
What is send an email to PRL Assist and include the state where the license must be verified?
What four key items should typically be reviewed in CAQH?
What are Re-Attestation, Active on Roster, Authorized by Provider, and Professional Liability Insurance?
When reviewing CAQH, what two things must be verified for a provider's Professional Liability Insurance?
What are the expiration date has not passed and the status is approved?
What status means the application has been reviewed by the Credentials Examiner and Credentials Lead and has been submitted to the committee?
What is Sent to CRC?
A credentialing file is missing required documentation. What should be done?
returning it for completion and follow-up
A provider's license was renewed, but they are outside the 30-day reinstatement window. What happens next?
What is they cannot be reinstated and must reapply through the Recruitment process?
While reviewing a provider's profile, you see"Not Authorized by Provider." What should you advise the provider to do?
What is grant ASH Global Authorization in CAQH and complete attestation if needed?
A provider is current with re-attestation and their Professional Liability Insurance is up to date in CAQH. What's the next step?
What is send the information to PRL Assist to request continuation of the recredentialing process?
Steps to Reverse a Termination?
What is
Items to check:
Authorized by provider -
Professional Liability Insurance.
Appeal date
Escalate to
CRDRECREDASSIST@ashn.com