Credentialing
Basics
Basics
What does PSV stand for in credentialing?
Primary Source Verification
What cred platform do we use to verify licenses and credentials?
Verifiable
Where does HR submit internal hire requests?
ASANA
Which organizations set credentialing standards we must follow?
CMS and NCQA
Which NFL team has a raven as its mascot?
Ravens
What’s the standard recredentialing cycle per CMS and NCQA?
Every 36 months
Which system generates provider denial reports?
Salesforce
Who loads provider rosters in SF?
Provider Relations
What must be maintained for all committee members?
Signed confidentiality and conflict of interest forms
Name the artist?
Frank Sinatra
Can a Clinical Social Worker have a CDS or a DEA?
None. They can't prescribe.
What system do we use for provider data and claims configuration?
HealthAxis (HAX)
Who handles removing internal hires AND plan providers from systems when offboarded/terminated?
Dylan
What must occur if a provider is denied credentialing?
Notify Claims (Claims updates HealthAxis)
What does "YOLO" stand for?
You Only Live Once
What database verifies provider malpractice history?
NPDB (National Practitioner Data Bank)
Which tool sends automated status updates to Clinical teams for internal hires?
ASANA
What triggers a provider’s file to move from “QA Review” to “Pending CMO/Committee”?
Audit Review by Coordinator
What kind of files require Level 2 peer review?
Death, License Issue, or claims over 350k
What city is known as the birthplace of Jazz?
New Orleans
Who approves providers after Level 2 peer review?
Credentialing Committee
Who sends CAQH and Onboarding forms for internal hires?
Tracy Hopewell (EHR Configuration & Integration Analyst)
What’s the average turnaround time for our internal credentialing process?
39 Days
What documentation is needed for an annual delegation audit?
PnP's, Credentialing Systems Controls Oversight Report, Minutes, Ongoing Monitoring Evidence, Roster
What is the name of the game show where contestants wear green tracksuits in a deadly competition?