Common use of Physician Credentialing Clause in Contracts

Physician Credentialing. The Carrier is encouraged to use an independent accrediting organization to validate its physician credentialing. If the Carrier's physicians meet the credentialing requirements of the credentialing organization, it has met and exceeds the minimum requirements listed below. Otherwise, the Carrier must demon­strate that it requires the following credential checks of all of its physicians, both during the initial hiring process and during periodic re-credentialing. As an alternative, the Carrier may demonstrate that the following credential checks are performed by a secondary source, such as a hospital. Verification of medical school graduation records. Routine check with local and/or state medical societies and/or boards. Routine check of the Department of Health and Human Services (DHHS) list of debarred providers. Routine check of the National Practitioner Data Bank.

Physician Credentialing. The Carrier is encouraged to use an independent accrediting organization to validate its physician credentialing. If the Carrier's physicians meet the credentialing requirements of the credentialing organization, it has met and exceeds the minimum requirements listed below. Otherwise, the Carrier must demon­strate demonstrate that it requires the following credential checks of all of its physicians, both during the initial hiring process and during periodic re-credentialing. As an alternative, the Carrier may demonstrate that the following credential checks are performed by a secondary source, such as a hospital. Verification of medical school graduation records. Routine check with local and/or state medical societies and/or boards. Routine check of the Department of Health and Human Services (DHHS) list of debarred providers. Routine check of the National Practitioner Data Bank.