Recredentialing definition

Recredentialing or being “recredentialed” means the
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Recredentialing means to confirm that a participating provider is in good standing by a health insurer or its designee and does not require submitting an application or going through a contracting and loading process.
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Recredentialing means the process by which a credentials verification entity verifies the credentials of a health care practitioner whose core credentials data, including all corrections, updates, and modifications thereto, are currently on file with the entity.
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Examples of Recredentialing in a sentence

  • Recredentialing must be completed within 36 months of prior credentialing or recredentialing activity (as required by CMS & DMHC).

  • Blue Shield shall be entitled to conduct audits of Group’s compliance with the criteria and standards of Delegated Credentialing and Recredentialing.

  • Recredentialing must be completed within 36 months of prior credentialing or recredentialing activity.

  • Recredentialing must be completed within 24 months of prior credentialing or recredentialing activity.

  • Recredentialing Primary source verification (PSV) Delegated Meet 90% of all NCQA Recredentialing standards (except PSV of Licenser).

  • Recredentialing - A process for the periodic reverification of clinical credentials (recredentialing, reappointment, or recertification) is described in the organization's policies and procedures.

  • Include list of all providers recredentialed on a quarterly basis (with quarterly report) • Annual audit of files of 5% or random sample of 50 to represent entire contracted network • Annual onsite assessment Recredentialing to include: License, clinical privileges, DEA/CDS, Board Certification, Malpractice insurance, Professional Liability claims, signed Attestation regarding any inability to perform and lack of present illegal drug use.

  • The Contractor shall conduct Credentialing and Recredentialing in compliance with 907 KAR 1:672 and federal law.

  • Recredentialing to include: License, clinical privileges, DEA/CDS, Board Certification, Malpractice Insurance, Professional Liability claims, signed Attestation regarding any inability to perform and lack of present illegal drug use.

  • Recredentialing Sanction information ý Delegated o Not delegated Full compliance with NCQA Recredentialing Standards regarding verification of information within 180 days prior to Committee approval date.


More Definitions of Recredentialing

Recredentialing means the verification and reverification of all education, licenses, certificates, insurance and liability or claims history to support the qualifications of any Healthcare Provider.
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Related to Recredentialing

  • Credentialing means the process of collecting, assessing, and validating qualifications and other relevant information pertaining to a health care provider to determine eligibility and to deliver Covered Services.

  • Training means instruction or teaching designed to impart a specific skill, as opposed to general knowledge.

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  • Specialist means either a physician or other health care professional who practices in a specific area other than those practiced by primary care providers, or a properly licensed, certified or registered individual health care provider whose practice is limited to rendering mental health services. For purposes of cost-share, this definition of “specialist” does not apply to dentists. BCBSAZ does not require you to obtain an authorization or referral to see a specialist.

  • Centers for Medicare and Medicaid Services or “CMS” means the federal office under the Secretary of the United States Department of Health and Human Services, responsible for the Medicare and Medicaid programs.

  • Testing means that element of inspection that determines the properties or elements, including functional operation of materials, equipment, or their components, by the application of established scientific principles and procedures.