Licensure and Certifications
Required licenses to practice medicine (for the majority of States)
What are State Medical License, Federal DEA License, and State Pharmacy License
DOP stands for
What is Delineation of Privileges
COI stands for
What is Certificate of Insurance
Information needed for Peer References
What is: First and Last Name, Credentials, Email Address, Phone Number
Document that details requirements and qualifications for medical staff membership
What is Medical Staff Bylaws
Document(s) that can dictate required certifications for your specialty
What is Delineation of Privileges (DOP) or Medical Staff Bylaws
Another name for case logs
What is Activity Log or Procedure Log
Typical Limits of Liability
What is 1 million per Claim and 3 million Annual Aggregate
True or False: Peer References should have directly observed the care you provided
What is True
What is CAQH and NPPES
Location(s) your DEA License is good for
What is the State you are licensed to practice medicine and prescribe controlled substances (this should be listed as the address)
Information that needs to be removed from case logs
What is PHI
Example of Red Flag
What is license being denied or suspended
True or False: Employments can also be listed as an affiliation on your credentialing application
What is True
Name of system used by Federal program Medicare
What is PECOS
Frequency to renew each license (NV timeframes)
What is: every 2 years for MD, every year for DO, every 3 years for DEA, and every 2 years for Pharmacy
Case logs can be requested through which departments
What are MSO, IT, Clinical Informatics, or Billing Office
Example of Malpractice Claim
What is being named in a complaint based on allegations of professional negligence or receiving notice of intent to commence litigation
True or False: Affiliations are always listed as an employment on your credentialing applications
What is False
Joint Federal and State Program
What is Mediciad
States that require a second license to prescribe controlled substances (name at least one)
What are Alabama, Connecticut, Delaware, Hawaii, Idaho, Illinois, Indiana, Iowa, Louisiana, Maryland, Massachusetts, Michigan, Missouri, Nevada, New Jersey, New Mexico, Oklahoma, Rhode Island, South Carolina, South Dakota, Utah, and Wyoming
Information that should be included on case logs
What is: Provider Name, Date of Service, CPT Code, CPT Code Description, and Count
Timeframe to report Malpractice Claim or Red Flag
What is ASAP (details should be in Medical Staff Bylaws and/or contract)
Person at HGH that can verify your affiliation
Who is Jessica Villarreal
Immunizations needed for credentialing
What are MMR, Varicella, HepB, Tdap, Flu, COVID, TB, and Mask Fit Test