What is Credentialing? Why Should I Care?
According to the National Library of Medicine, credentialing simply is the process of assessing the academic qualifications and clinical practice history of a healthcare provider.??
Network Credentialling is vital to ensure that all providers have the certifications and experience to deliver good quality care. Recredentialling and ongoing monitoring, for network purposes, is the ongoing process to ensure that credentialed providers continue to meet the criteria for network participation. It is important to understand what credentialing is and realize that not all network organizations perform credentialing to the same extent, or at all.?
The Coventry Network is credentialed and re-credentialed by Verisys, a NCQA-accredited Credentials Verification Organization (CVO). For individual practitioners, the Coventry Credentialing Program secures primary source verification on the following elements:?
In addition to the applicable criteria listed above, facilities are reviewed to ensure:?
Verisys also performs ongoing adverse event monitoring for Coventry network providers. This monitoring checks for both federal and state exclusions and sanctions. An adverse event may result in immediate network termination or review by Coventry’s Quality Committee dependent on the nature of the adverse event.?
At Coventry, we take network management seriously. We want to do everything possible to ensure that the providers in our network have the education and experience needed when treating individuals who have experienced an injury or illness as a result of a workplace incident or automobile accident.??