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Ask the expert: Does the NCQA allow provisional credentialing for initial appointments at acute care facilities?

Credentialing Resource Center Connection, September 20, 2007

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Provisional credentialing is permitted, for those practitioners who are applying to the organization for the first time (i.e., provisional credentialing does not apply to reappointment/recredentialing). A practitioner may be provisionally credentialed only one time. Provisional credentialing applies, provided that:

• Current licensure is primary source verified within the past 180 days
• A five-year history of malpractice claims and settlements is obtained from the carrier of the NPDB query results are obtained within the past 180 days
• There is a current, signed application (with attestation within the past 365 days, some exceptions may apply)
• The credentialing committee or medical director considers the above information as it provisionally credentials the applicant
• The provisional period is granted for no longer than 60 days
   
  More information about NCQA requirements can be found in Verify and Comply, Fourth Edition by Carol S. Cairns, CPMSM, CPCS, available here.

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