1. North Carolina Association Medical Staff Services May 27, 2016 Renee Aird Dengler, RN, MS, CPMSM, CPCS NCQA CVO & NCQA CR Certification

2. Onsite and Offsite evaluation Survey every two years Review Oversight Committee NCQA CVO & NCQA CR Certification

3. NCQA’s Credentials Verification Organization (CVO) Certification Program evaluates credentials verification operations and the processes that the CVO uses to continuously improve the service it provides to its managed care clients. CVO certification is available to organizations that conduct credentials verification, report the credentialing information to clients and have systems in place to protect the confidentiality and integrity of the information. Source: NCQA website NCQA CVO Certification

4. NCQA’s CVO Certification program evaluates specific certification functions of organizations that provide credentials verification services. CVOs may choose to be evaluated in one or more “Certification Options”. Each option is specific to one of the certification functions. Organizations eligible for CVO certification must meet core requirement as well as the requirements for the Certification Options they choose. Source: NCQA website NCQA CVO Certification Options

5. CVO 1 – Written Policies and Procedures CVO 2 – Process for Internal Continuous Quality Improvement CVO 3 – Protecting Credentialing Information NCQA CVO Standards

6. CVO 4 – 13 – Certification Options – Licensure to Practice – DEA or CDS Certification – Education and Training – Work History – Malpractice Claims History – Medical Board Sanctions – Medicare/Medicaid Sanctions – Practitioner Application Processing – Application and Attestation Content – Ongoing Monitoring of Sanctions NCQA CVO Standards

7. NCQA’s Certification in UM/CR program is available to a variety or organizations that perform Credentialing (CR) and/or Utilization Management (UM). The standards represent a merger of the POC (Physician Organization Certification) and OC (Organization Certification) products into a single set of standards designed for organizations that provide full scope CR or UM services or both. NCQA Certification provides these organizations the opportunity to demonstrate the quality of their UM and CR programs. Source: NCQA website NCQA Certification in UM/CR

8. These standards include not only credentialing verification but the entire scope of the credentialing and recredentialing program and process including decision-making. NCQA Credentialing and Recredentialing (CR)

9. Internal Quality Improvement Process Agreement and Collaboration with Clients Protecting Credentialing Information Credentialing Policies Credentialing Committee Credentialing Verification NCQA Credentialing and Recredentialing (CR)

10. Recredentialing Cycle Length Practitioner Office Site Quality Ongoing Monitoring Notification to Authorities and Practitioner Appeal Rights Delegation of Credentialing NCQA Credentialing and Recredentialing (CR)

11. Clear Policies and Procedures Graphs / Charts / Statistics / Minutes Aggregate data/ trends Opportunities for and barriers to improvement Assessment / analysis Link to Standards – Tab, Highlight Survey

12. Documents Explain Sample Reports Don’t tell them – Show them Survey

13. CELEBRATE YOUR SUCCESS!!! Survey

14. QUESTIONS