Page 1 of 17 CPCS Medical Staff Credentialing & Standards CPCS Medical Staff Credentialing & Standards.pdf
CPCS Medical Staff Credentialing &
Standards
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.
Certified Provider Credentialing Specialist
All licensed Independent practitioners must be credentialed and privileged through the
organized Medical staff structure.
Initial Appointment / Clinical privileges/ practioners covered according to TJC
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 the NCQA
Page 1 CPCS Medical Staff Credentialing & Standards CPCS Medical Staff Credentialing & Standards.pdf
,Page 2 of 17 CPCS Medical Staff Credentialing & Standards CPCS Medical Staff Credentialing & Standards.pdf
The Governing body determines, in accordance with Staye Law, which categories of
practitioners are eligible for appointment to the medical staff. At a minimum the medical staff
must be composed of MD 's and DO's.
Initial Appointment / Clinical privileges/ practioners covered according to CMS
Requires verification from the medical school or accepted PSV
Verification of Medical education according to the TJC
The AMA, the AOA, and the ECFMG
TJC Accepted PSV for medical education
Requires HP/CVO the highest of three levels of education and training.
Verification of Medical education according to the NCQA
Page 2 CPCS Medical Staff Credentialing & Standards CPCS Medical Staff Credentialing & Standards.pdf
, Page 3 of 17 CPCS Medical Staff Credentialing & Standards CPCS Medical Staff Credentialing & Standards.pdf
Graduation from medical or professional school, residency, board certification.
The three levels of education and training as defined by NCQA
The medical staff must have a mechanism to examine evidence of professional education
Verification of Medical education according to CMS
Requires verification from the primary source or designated equivalent sources.
Verification of postgraduate training according to TJC
AMA and AOA
TJC accepted PSV for postgraduate training
The highest of the three levels of education and training attained. If board certified, than board
certification suffices.
Verification of postgraduate training according to NCQA
Page 3 CPCS Medical Staff Credentialing & Standards CPCS Medical Staff Credentialing & Standards.pdf
CPCS Medical Staff Credentialing &
Standards
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.
Certified Provider Credentialing Specialist
All licensed Independent practitioners must be credentialed and privileged through the
organized Medical staff structure.
Initial Appointment / Clinical privileges/ practioners covered according to TJC
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 the NCQA
Page 1 CPCS Medical Staff Credentialing & Standards CPCS Medical Staff Credentialing & Standards.pdf
,Page 2 of 17 CPCS Medical Staff Credentialing & Standards CPCS Medical Staff Credentialing & Standards.pdf
The Governing body determines, in accordance with Staye Law, which categories of
practitioners are eligible for appointment to the medical staff. At a minimum the medical staff
must be composed of MD 's and DO's.
Initial Appointment / Clinical privileges/ practioners covered according to CMS
Requires verification from the medical school or accepted PSV
Verification of Medical education according to the TJC
The AMA, the AOA, and the ECFMG
TJC Accepted PSV for medical education
Requires HP/CVO the highest of three levels of education and training.
Verification of Medical education according to the NCQA
Page 2 CPCS Medical Staff Credentialing & Standards CPCS Medical Staff Credentialing & Standards.pdf
, Page 3 of 17 CPCS Medical Staff Credentialing & Standards CPCS Medical Staff Credentialing & Standards.pdf
Graduation from medical or professional school, residency, board certification.
The three levels of education and training as defined by NCQA
The medical staff must have a mechanism to examine evidence of professional education
Verification of Medical education according to CMS
Requires verification from the primary source or designated equivalent sources.
Verification of postgraduate training according to TJC
AMA and AOA
TJC accepted PSV for postgraduate training
The highest of the three levels of education and training attained. If board certified, than board
certification suffices.
Verification of postgraduate training according to NCQA
Page 3 CPCS Medical Staff Credentialing & Standards CPCS Medical Staff Credentialing & Standards.pdf
