Fifth Avenue Healthcare Services (FAHS) and our affiliated lines of services including CVO services with our 5ACVO team, and affiliated sister company Primoris Credentialing Network, have completed the lengthy, intricate auditing process and obtained NCQA credentialing accreditation. The National Committee for Quality Assurance (NCQA) is a private, nonprofit organization dedicated to improving health care quality.
NCQA President Margaret E. O’Kane states, “Achieving NCQA Credentialing Accreditation demonstrates that Fifth Avenue Healthcare Services has the systems, process, and personnel in place to conduct credentialing in accordance with the strictest quality standards.”
Margaret E. O’Kane
NCQA accredits and certifies a wide range of health care organizations. It also recognizes clinicians and practices in key areas of performance. NCQA’s Healthcare Effectiveness Data and Information Set (HEDIS®) is the most widely used performance measurement tool in health care. NCQA’s website contains information to help consumers, employers and others make more informed health care choices.
An organization that has been awarded the NCQA Credentialing Accreditation has proven it can maintain an elevated level of quality credentialing for its clients. Credentialing accreditation helps ensure adherence to a set standard of care as well as increasing the credibility and authority of that organization.
Organizations that seek NCQA accreditation must also be periodically evaluated. Healthcare is an industry that demands constant monitoring. A patient’s safety should not be left to occasional discretionary measures. For more information on NCQA, please visit them online at NCQA.org, Twitter, Facebook and/or on LinkedIn.
How To Receive NCQA Credentialing Accreditation
NCQA Credentialing Accreditation assesses any organization that offers credentialing services to ensure the organization can maintain a superior network for its contracted clients. Credentialing services include:
- Verifying healthcare provider credentials through a primary source or a contracted agent of the primary source.
- Reviewing provider credentials.
- Making credentialing recommendations via a committee.
- Monitoring provider sanctions and complaints between re-credentialing cycles.
Credentialing organizations must also meet certain criteria before pursuing accreditation
Before pursuing NCQA accreditation, credentialing organizations must pursue the following four things:
- not be licensed as an HMO, POS, PPO, or EPO.
- not be eligible for NCQA Accreditation as a health plan or an MBHO.
- perform credentialing functions directly or via a contractual agreement.
- perform credentialing tasks for at least 50% of the practitioner network.
Once it is determined that an organization is eligible for accreditation, NCQA will then review its policies and procedures
NCQA scores are based on satisfying a specified number of factors. For instance, in one section, an organization must meet 8 to 11 factors to pass that section. In another, the organization must meet all the factors.
Factors that will be evaluated include:
- The type of practitioners that are credentialed.
- The verification sources an organization uses.
- The organization’s decision-making criteria and process.
- The process for determining and approving files that meet the decision-making criteria.
- The organization’s level of confidentiality.
- Nondiscriminatory credentialing procedures.
- The policies addressing discrepancies in credentialing information.
- How well the organization notifies practitioners about their right to review the information submitted to support their credentialing application, correct incorrect information, and receive the status of their credentialing application upon request.
- The timeliness of the notification process regarding credentialing decisions.
- The method information is received, stored, reviewed, and tracked.
- How the organization tracks any modifications made to credentialing information.
- The policies regarding the authorization to modify information.
- The audit process that identifies system security control risks.
- How the organization limits physical access to the credentialing information they have obtained.
- How the organization acquires advice from practitioners when it makes credentialing decisions.
- The credentialing committee’s review process.
- How the organization presents all relevant files to the credentialing committee.
- How promptly the organization conducts the verification of a practitioner’s information.
- How the organization verifies sanction information for credentialing.
- The credentialing application.
- The ability to identify and act on important quality issues in the time between formal credentialing.
- The organization’s objectivity when deciding on how to deal with a practitioner who does not meet its quality standards.
- The policies that dictate the appeal process should a practitioner not meet standards.
- The quality of an organization’s contracted providers.
- How an organization delegates credentialing responsibilities.
Fifth Avenue Healthcare Services was successfully evaluated, earning acknowledgment for its quality improvement efforts that were evident throughout the survey process. The company joins an elite tier of approximately 90 organizations that have also earned NCQA Credentialing Accreditation.
What Does Accreditation Mean For Fifth Avenue Healthcare Services?
Using an NCQA-accredited credentialing company can help make sure that a healthcare provider is promptly and accurately credentialed so they can start seeing patients quickly. Beginning the billing process as soon as possible can expedite and increase revenue. An NCQA-accredited credentialing company can typically be relied on to allow providers to get to work promptly because it follows credentialing’s most effective practices.
NCQA Credentialing Accreditation can positively impact a credentialing organization’s performance. It can also enhance the quality of the credentialing process. The benefits can filter down to the providers and their patients.
Accreditation can help credentialing organizations:
- Deliver streamlined and precise credentialing: Punctuality and accuracy are crucial aspects that help confirm that only qualified physicians can practice medicine.
- Follow state requirements: A credentialing organization that understands the requirements can adhere to them and operate more effectively and without interruption.
- Grow revenue streams and secure new contracts: Accredited organizations can use their status when marketing their services.
- Exhibit their programs’ qualities to employers, regulatory agencies, and health plans: An organization that demonstrates the industry’s best practices can potentially be looked at as a leader in its field.
How Important is NCQA Credentialing Accreditation?
Credentialing is a vital piece of the healthcare system. Organizations must prove the qualifications of their licensed medical professionals by researching their backgrounds and legitimacy. It is a critical and complex process. NCQA Credentialing Accreditation protects patients. It provides the foundation for organizations to employ superior standards for the credentialing of healthcare professionals. The guidelines NCQA sets can help credentialing organizations identify areas for improvement and keep the industry strong.
NCQA Credentialing Accredited Fifth Avenue Healthcare Services provides smarter, simpler and better credentialing to the 1000’s of providers served. Without NCQA Credentialing Accredited companies like Fifth Avenue Healthcare Services, the healthcare field would be less safe for patients who need top-notch care.
More information about Fifth Avenue Healthcare Services
Fifth Avenue Healthcare Services is a NCQA Credentialing Accredited family of healthcare companies. Sister companies include 5ACVO (credentialing and primary source verification specialists), Fifth Avenue Agency (MPLI and medical malpractice insurance specialists), and Primoris Credentialing Network (credentialing and provider enrollment specialists with 54+ health plan and network provider enrollment options).
Fifth Avenue Healthcare Services originally published this article here. For information on Fifth Avenue Healthcare Services, please visit FifthAvenueHealthcareService.com or Contact Us.
