What is Provider Recredentialing?

The recredentialing process, which verifies the education and training of providers and notifies healthcare organizations of abuse or fraud, while possibly burdensome to administration, can help hospitals avoid millions in civil monetary penalties, delayed reimbursement and litigation. In most states, recredentialing takes place every two years, while health plans may also have additional requirements. It can take weeks or months to complete the recredentialing process and a provider should be notified at least 60 days prior to the due date to begin the application process, which should be available online. Information that must be up-to-date includes state licenses, board certification, work history, malpractice claim history and current malpractice insurance coverage, among others. Those practitioners who are denied recredentialing should be notified with a written notice that includes reasons for denial and sources of data so that they can file an appeal if they so choose. Documents and evidence of the application should be maintained in the practitioner’s credentials files.


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Post By Ken Shafton (2,204 Posts)