Does Your Credentialing Meet Standards? Blog Feature
Melissa Outlaw

By: Melissa Outlaw on October 9th, 2014

Print/Save as PDF

Does Your Credentialing Meet Standards?

Healthcare Provider Credentialing

Using words like documentation, best practices, and standards can often exude a negative emotion or reaction. They seem to conjure feelings of defeat or mounds of paperwork. However, the weight of meeting requirements doesn't have to become your organizations reality!

Credentialing Software, CredentialingThe intent of guidelines and standards are to serve the people and organizations that implement them. They should bring consistency, proficiency, and peace of mind. Documenting processes should alleviate the guesswork and stand as a record for future reference. When used properly, documentation can also facilitate an environment of dexterity, poise, and efficiency while mitigating any inconsistent or conflicting outcomes. When there is a firm paper trail for each procedure and action, audits become mundane instead of burdensome and alarming.

What to Document

In the “verification of credentials” process, best practice is to have the following information for each verification, regardless of the type of standard (TJC, DNV, NCQA, etc.) your organization adheres to. And in doing so, random audits will be a natural, welcomed step in your process.

  • Retain the name and title of the person who verified the information provided. If, for instance, a phone call is made, document the name and title of the employee who made that call. For years to come, their name and title should remain with the record regardless of that employee’s retention. If a phone call is the method used, it should be recorded or followed up with an email or fax so there is documentation of information provided.

  • There is not a need to document every attempt to obtain the verification. Simply record the date and time the verification was successfully obtained. The date is of utmost importance for items that aren’t static- such as licensure.

  • It is of utmost importance to note the source of the verification. Given the ample methods available, this source could greatly vary. It could be a person you spoke with, a fax from a human resource manager, or the URL of the website you searched. As previously stated, if it is a person, obtain and document the name and title.

  • You may run into discrepancies or distinctions between the information from the provider/applicant and what can actually be verified. Should this be the case, document the discrepancy. If discrepancies are found, further action may be in order. Some industries require the applicant certify and/or attest that information provided is accurate and in some cases, discrepancies found may be enough to prevent an applicant from being hired. Also, identified gaps in employment/education may be a red flag that the applicant is hiding information.

  • Many industries require verification to be attached to the file. This is something your organization should embrace! In the event of a dispute, you have the ability to show attorneys or auditors the information provided, who provided the information, and why decisions were made.

Credentialing software is a technology available to arm those performing the verifications and your organization. Excellent credentialing software will document many of these processes for you and will do so in a way that meets your organization’s requirements. There are some instances that shortcuts can be taken; verification of credentials is not one of them.


About Melissa Outlaw

Melissa Outlaw is a Vice President, Customer Success with symplr. Melissa and her team assist clients in learning and implementing our provider management software - credentialing, privileging, peer review, quality and event reporting applications. She supports clients in benchmarking current internal practices, identifying potential efficiencies, then driving the integration of technology with process improvement to reduce time of service and operating expenses. She works extensively with decentralized, multi-facility organizations in transitioning to a shared service center as well as assisting healthcare organizations bridge the gap between procedures performed by a provider and their privileges granted.