Credentialing System Design QMCG Quality Management Consulting Group

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Quality Management Services: Credentialing System Design

GOAL:

To create a credentialing system for a health care organization that:

Establishes the minimum requirements for provider status

Facilitates the regular and objective evaluation of provider performance

Meets requirements for accreditation by JCAHO and other organizations such as NCQA

WHEN NEEDED:

QMCG Credentialing System Design is appropriate to develop or redesign standards and systems for credentialing and re-credentialing providers in a health care organization in a way that will give the organization a competitive advantage while measuring quality.

DESCRIPTION:

QMCG Credentialing System Design Service assists the organization in the design of a credentialing and re-credentialing process that will satisfy the evolving requirements of the organization's market and the development and implementation of a plan. Flexible components may include:

Credentialing committee development or redesign

Initial credentialing process design or redesign

Re-credentialing process design or redesign

Privilege delineation criteria development

Process for the structured onsite review of primary care practice sites (when indicated)

Organization performance improvement processes (i.e. hospitals, surgi-centers, home health agencies, etc.)

Provider profile of member satisfaction, quality and utilization data, etc.

Privilege reduction, suspension or termination procedures and policies

Appeals process

Data requirements summary

Plan for implementation

DURATION:

The design and implementation of the Credentialing System Design process can be accomplished in 3 to 5 months depending upon the needs and time frames established by the committee members.