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Ask the expert: What do I need to include in the acknowledgement section of the medical staff credentialing application?

Medical Staff Leader Connection, June 24, 2009

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A key part to any credentialing application is the attestation, acknowledgement, and release forms. These documents protect not only your organization, but also the organizations that release information to you throughout the credentialing process. When developing the acknowledgment section, keep the following key elements in mind:

1. Applicant attests that the information provided on the application and associated documents is true, correct, and complete to the best of his or her knowledge
2. Applicant attests that he or she has requested only those privileges that he or she is qualified to perform
3. Applicant attests that he or she agrees to be bound by the bylaws, rules and regulations, and policies and procedures of the organization
4. Applicant attests that he or she agrees to notify the organization within a specified amount of time as set by the organization (e.g., 15 days) of any material change to the information reported on the application, including but not limited to, changes in status at other organizations, restrictions to any license, commencement of a formal investigation, changes in physical or mental health, etc.
5. Applicant attests that he or she has read and understands the attestation, acknowledgement, and release forms.

This weeks question and answer are from The Credentialing Coordinator’s Handbook by Anne Roberts, CPMSM, CPCS, now availablat a reduced price!

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