NCQA time limits on professional liability /malpractice for CVO
Answer
The credentials information must be valid, current, and verified within 305 calendar days
prior to submission to each client.
FSMB
Answer
Federation of state medical boards
Equal for license sanctions except URAC
Equal for MC/MA sanctions except URAC
ABMS
Answer
American board of medical specialties
Equivalent for Board Certification
ECFMG
Answer
Education commission on foreign medical graduates
Equivalent for foreign education (med school)
AMA/AOA Master File
Answer
Equivalent for training (residency)
1
,Equivalent for US & PR education (med school)
Equal for boards (AOA only)
Equal for DEA for NCQA (AMA only)
NPDB
Answer
National practitioner data bank
Equivalent for license sanctions and MC/MA sanctions
Equivalent for claims history
QAPI
Answer
Performance review for HFAP
NCQA ongoing monitoring?
Answer
Sanctions, complaints, quality issues
TJC ongoing monitoring?
Answer
License, competence (OPPE)
TJC disaster privilege verification in addition to ID?
Answer
Hospital ID
License or PSV of license
ID of part of group
2
, Process for temp privileges for HFAP?
Answer
Granted by dept chief/chair and CEO/designee
Verify license, DEA, COI, 1 reference
Process for temp privilege for TJC?
Answer
Granted by CEO/Designee upon recommendation of med staff president/designee
For urgent pt need verify license and competence
For pending approval verify license, training, experience, competency, ability, NPDB, com-
plete app
Licensure
Answer
A license is the authority a government agency grants an individual to practice a profession.
State Licensure
Answer
Regulation of medical and other professional practice is a state function. States exercise the
regulation of medical practice through licensing laws.
What is the verification time limit for licensure per NCQA CVO standards?
Answer
120 days
According to the Joint Commission standards, initial appointments to the medical staff are
not to exceed what time period?
3
Answer
The credentials information must be valid, current, and verified within 305 calendar days
prior to submission to each client.
FSMB
Answer
Federation of state medical boards
Equal for license sanctions except URAC
Equal for MC/MA sanctions except URAC
ABMS
Answer
American board of medical specialties
Equivalent for Board Certification
ECFMG
Answer
Education commission on foreign medical graduates
Equivalent for foreign education (med school)
AMA/AOA Master File
Answer
Equivalent for training (residency)
1
,Equivalent for US & PR education (med school)
Equal for boards (AOA only)
Equal for DEA for NCQA (AMA only)
NPDB
Answer
National practitioner data bank
Equivalent for license sanctions and MC/MA sanctions
Equivalent for claims history
QAPI
Answer
Performance review for HFAP
NCQA ongoing monitoring?
Answer
Sanctions, complaints, quality issues
TJC ongoing monitoring?
Answer
License, competence (OPPE)
TJC disaster privilege verification in addition to ID?
Answer
Hospital ID
License or PSV of license
ID of part of group
2
, Process for temp privileges for HFAP?
Answer
Granted by dept chief/chair and CEO/designee
Verify license, DEA, COI, 1 reference
Process for temp privilege for TJC?
Answer
Granted by CEO/Designee upon recommendation of med staff president/designee
For urgent pt need verify license and competence
For pending approval verify license, training, experience, competency, ability, NPDB, com-
plete app
Licensure
Answer
A license is the authority a government agency grants an individual to practice a profession.
State Licensure
Answer
Regulation of medical and other professional practice is a state function. States exercise the
regulation of medical practice through licensing laws.
What is the verification time limit for licensure per NCQA CVO standards?
Answer
120 days
According to the Joint Commission standards, initial appointments to the medical staff are
not to exceed what time period?
3
