Certified Provider Credentialing Specialist
ANSWER
The Certified Provider Credentialing Specialist (CPCS) is typically employed or contracted by
a healthcare organization including, but not limited to, hospitals (health systems), health
plans, ambulatory care settings, group practices, and credentialing verification organizations.
Initial Appointment / Clinical privileges/ practioners covered according to the TJC
ANSWER
All licensed Independent practitioners must be credentialed and privileged through the or-
ganized Medical staff structure
Initial Appointment / Clinical privileges/ practioners covered according to the NCQA
ANSWER
HP's and MBHO's must have documented Credentialing policies and procedures that apply
to all practitioners who provide care to the organizations members
Initial Appointment / Clinical privileges/ practioners covered according to CMS
ANSWER
The Governing body determines, in accordance with Staye Law, which categories of practi-
tioners are eligible for appointment to the medical staff. At a minimum the medical staff
must be composed of MD 's and DO's.
Verification of Medical education according to the TJC
ANSWER
Requires verification from the medical school or accepted PSV
1
, TJC Accepted PSV for medical education
ANSWER
The AMA, the AOA, and the ECFMG
Verification of Medical education according to the NCQA
ANSWER
Requires HP/CVO the highest of three levels of education and training.
The three levels of education and training as defined by NCQA
ANSWER
Graduation from medical or professional school, residency, board certification.
Verification of Medical education according to CMS
ANSWER
The medical staff must have a mechanism to examine evidence of professional education
Verification of postgraduate training according to TJC
ANSWER
Requires verification from the primary source or designated equivalent sources.
TJC accepted PSV for postgraduate training
ANSWER
AMA and AOA
Verification of postgraduate training according to NCQA
ANSWER
2
ANSWER
The Certified Provider Credentialing Specialist (CPCS) is typically employed or contracted by
a healthcare organization including, but not limited to, hospitals (health systems), health
plans, ambulatory care settings, group practices, and credentialing verification organizations.
Initial Appointment / Clinical privileges/ practioners covered according to the TJC
ANSWER
All licensed Independent practitioners must be credentialed and privileged through the or-
ganized Medical staff structure
Initial Appointment / Clinical privileges/ practioners covered according to the NCQA
ANSWER
HP's and MBHO's must have documented Credentialing policies and procedures that apply
to all practitioners who provide care to the organizations members
Initial Appointment / Clinical privileges/ practioners covered according to CMS
ANSWER
The Governing body determines, in accordance with Staye Law, which categories of practi-
tioners are eligible for appointment to the medical staff. At a minimum the medical staff
must be composed of MD 's and DO's.
Verification of Medical education according to the TJC
ANSWER
Requires verification from the medical school or accepted PSV
1
, TJC Accepted PSV for medical education
ANSWER
The AMA, the AOA, and the ECFMG
Verification of Medical education according to the NCQA
ANSWER
Requires HP/CVO the highest of three levels of education and training.
The three levels of education and training as defined by NCQA
ANSWER
Graduation from medical or professional school, residency, board certification.
Verification of Medical education according to CMS
ANSWER
The medical staff must have a mechanism to examine evidence of professional education
Verification of postgraduate training according to TJC
ANSWER
Requires verification from the primary source or designated equivalent sources.
TJC accepted PSV for postgraduate training
ANSWER
AMA and AOA
Verification of postgraduate training according to NCQA
ANSWER
2
