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Steps in provider credentialing Form: What You Should Know
In order to properly credential a health care provider, the health insurance company or payer does the following: Credentials must: · Conduct thorough and independent tests for a provider's competence and competence 1) Conduct a general assessment (evaluator, interview). a. A physician, physician assistant, nurse practitioner, nurse midwife, psychologist, social worker, physician assistant trainee (PA), physician assistant trainee (PAT), or assistant clinical instructor (ACE) who is knowledgeable about the physician's specialty or experience is responsible for conducting a general assessment. b. A person conducting an assessment must have the following qualifications: · Age 25 years and older · A baccalaureate, diploma, master of science, doctorate or equivalent professional credentials in a discipline recognized by the United States board for medical education, board for licensing, or equivalent state or national credentialing agency · Good moral character · A baccalaureate, diploma, master of science, doctorate, or equivalent professional credentials in any specialty recognized by the United States board for medical education, board for licensing, or equivalent state or national credentialing agency that will enhance the performance of the certification or examinations and that are recognized by the United States department of health and human services (HHS) and the federal government (e.g.
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