NATIONAL CREDENTIALING FORUM FEBRUARY 20 2004 NAMSS CREDENTIALING

NATIONAL CREDENTIALING FORUM FEBRUARY 20, 2004 NAMSS CREDENTIALING ELEMENTS TASK FORCE POSITION PAPER PRESENTED BY: CHRISTINA GILES MEDICAL STAFF SOLUTIONS & EDGE-U-CATE LLC February 20, 2004 Prepared by: Medical Staff Solutions and Edge-U-Cate, LLC.

NAMSS CREDENTIALING ELEMENTS TASK FORCE l l l 2 Commissioned June, 2003 by NAMSS Board of Directors Charge: Develop a position paper recommending the critical data elements to be included in all application processes. Members: Variety of backgrounds and experience; all were CMSC or CPCS certified; knowledgeable of NCQA, JCAHO, CMS and URAC standards and legislative mandates February 20, 2004 Prepared by: Medical Staff Solutions and Edge-U-Cate, LLC.

NAMSS CREDENTIALING ELEMENTS TASK FORCE l l 3 NAMSS members have been encouraged to utilize the position paper as a tool to evaluate credentialing applications. Tool may not meet individual state laws or statutes regarding credentialing. Legal counsel should be contacted by each organization prior to finalizing a credentialing document. February 20, 2004 Prepared by: Medical Staff Solutions and Edge-U-Cate, LLC.

NAMSS CREDENTIALING ELEMENTS TASK FORCE Position paper was forwarded for review and comment to NCQA and JCAHO: – 4 JCAHO: “…. the position paper includes a comprehensive list of information required by the JCAHO standards to credential and privilege applicants. ” February 20, 2004 Prepared by: Medical Staff Solutions and Edge-U-Cate, LLC.

NAMSS CREDENTIALING ELEMENTS TASK FORCE NCQA: “…. NCQA supports efforts to standardize the credentialing process and align requirements. As an organization whose members are experts in the areas of practitioner credentialing and member services, it certainly makes sense for NAMSS to participate in such efforts. ” 5 February 20, 2004 Prepared by: Medical Staff Solutions and Edge-U-Cate, LLC.

Common Approach l l l 6 NAMSS Credentialing Elements Task Force September, 2003 Revised 1/7/04 Participants from NAMSS – various experience backgrounds Reviewed and endorsed by NCQA and JCAHO February 20, 2004 l l l NCF Core credentialing elements – 1996 Revised June, 2003 Participants from 23 different organizations including NAMSS, JCAHO and NCQA, among others Prepared by: Medical Staff Solutions and Edge-U-Cate, LLC.

SOME DIFFERENCES l l NAMSS Fifth Pathway Additional Training or Experience related to privileges requested Malpractice Carriers- Past 10 years Past Medical Practices or Clinical Employment NCF l l l l 7 February 20, 2004 Gender Military Service Specialty Certification – Date Qualified – Date Qualification Expires Malpractice Carriers – Past 5 years Office Billing Information Academic Appointments References Prepared by: Medical Staff Solutions and Edge-U-Cate, LLC.

OPTIONS Continue revising and maintaining NCF Core Credentialing Data Form OR Endorse the elements proposed by NAMSS OR Work with NAMSS Task Force to include specific items on the NCF form not currently included in NAMSS list 8 February 20, 2004 Prepared by: Medical Staff Solutions and Edge-U-Cate, LLC.

THE FUTURE l Whatever decision is made …… NCF could endorse the idea of publicizing the acceptable product 9 February 20, 2004 Prepared by: Medical Staff Solutions and Edge-U-Cate, LLC.