2004 Credentialing & CVO Standards National Credentialing Forum February 20, 2004

2004 Credentialing Standard Changes 2004 CVO Standard Changes Web Based Survey Tool Objectives

2003 MCO Standards CR 1: Policies CR 2: Committee CR 3: Initial Verification CR 4: Application and Attestation CR 5: Initial Sanction Information CR 6: Site Visits CR 7: Recredentialing Verification CR 8: Recredentialing Sanction Information CR 9: Performance Monitoring CR 10: Ongoing Monitoring of Sanctions and Complaints CR 11: Assessment of Providers

2004 Standard Changes Documented process to ensure accuracy of member materials (CR 1) Committee must only review credentials that do not meet criteria (CR 2) Verification of licensure becomes separate element (CR 3 & 7) Review of quality issues in CR 9 incorporated into CR 10

Current CVO Standards CVO 1 Written Policies and Procedures CVO 2 Process for Internal Continuous Quality Improvement CVO 4 Protection of Credentialing Information CVO 5 Application and Attestation CVO 6 Ongoing Monitoring CVO 3 Verification and Reporting State Licensure DEA Certificate Education and Training Malpractice History Malpractice Insurance Medical Board Sanctions Medicare/Medicaid Sanctions Standards 50 % of composite 90% on CVO 6 At least 70% on assessed elements Scoring

2004 CVO Standards Changes identified three core standards and designated them must-pass for CVO certification made Application and Attestation (former CVO 5) and Ongoing Monitoring (former CVO 6) separately scored certifications added Work History as a certification added CVO Application Content (CVO 5) as a certification eliminated Malpractice Insurance as a certification.

2004 CVO Standards CVO 1 Written Policies and Procedures CVO 2 Process for Internal Continuous Quality Improvement CVO 3 Protection of Credentialing Information CVO 4 State Licensure* CVO 5 DEA Certificate* CVO 6 Education and Training* CVO 7 Work History* CVO 8 Malpractice History* CVO 9 Medical Board Sanctions* CVO 10 Medicare/Medicaid Sanctions* CVO 11 Application and Attestation Processing* CVO 12 Application and Attestation Content CVO 13 Ongoing Monitoring of Sanctions Core Standards Must-pass all elements Separately scored standards Scoring Certifications *file review standards

Why was the process redesigned? Increase efficiency and quality of evaluation Enable cost-effective, timely process Maintain the rigor of accreditation Provide readiness evaluation tool for organizations Interactive Survey System

What Is the Interactive Survey System? Online, interactive version of the documents needed for NCQA accreditation, certification or recognition programs Two components –Standards and Guidelines (SGs) –Survey Tool (ST or “Tool”)

Standards and Guidelines Available in print or e-publication version Purchase license to use on ISS Web-based and fully searchable

The Survey Tool Interactive tool for readiness evaluation and information transfer to NCQA –Complete question/answer format for MCO survey preparation –Gives numeric results based on answers –Links supporting documents to show compliance –Captures notes and comments for project management –Includes the SGs in a drill-down format

Survey Process Survey Tool Submitted Off-site review (non-file review standards) On-site review (file review standards and other confidential information)