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|Credentials Verification Office | |

| |Section |Policy |

| |V |1 |

| |

|TITLE: Verification for Medical Staff Initial Appointment (MD, DO, DPM, DMD) |

| |

|Date of Implementation: July 1, 2000 |

|Revised: 9/6/00; 10/19/00, 11/2/00; 3/17/02; 11/5/02; |

|11/14/03; 11/12/04; 11/1/05; 11/17/06; |

|11/17/07; 11/17/08; 11/17/09; 2/23/10; |

|11/10; 11/11; 5/12; 11/12; 5/21/13, 11/13 |

| | Signed Original on File at the CVO Office |

|Date of Last Review: 11/2013 |Signature: _____________________________ |

The UPMC Credentials Verification Office (UPMC CVO) will provide centralized application processing and credentials verification services for the facilities and organizations of the University of Pittsburgh Medical Center (UPMC). Verification services will be provided in accordance with applicable law and regulation and accrediting body standards, including, but not limited to the Pennsylvania Department of Health (DOH), the Department of Public Welfare (DPW), The Joint Commission (TJC), the American Osteopathic Association (AOA), and the National Committee for Quality Assurance (NCQA).

For Medical Staff initial appointment, primary source verification is performed to confirm the following credentials:

1. Valid, unrestricted license to practice

2. License Sanctions

3. Valid DEA

4. Board Certification

5. Malpractice Insurance and History

6. Medical Education

7. Training Programs

8. Hospital Affiliations

9. Professional Activities and Work History

10. Military Service

11. Teaching Appointments

12. Peer References

13. Competence Evaluation

14. Medicare/Medicaid Sanctions

15. Criminal Background Check

A listing of each element that will be primary source verified and the accepted primary sources can be found in the Verification Sources policy.

When written verification is requested, an addressed return envelope is provided.

NOTE: All documents and verification responses are imported or scanned into the MSO software. The document and response images can be viewed or printed. (See the Document Scanning policy).

I. Licensure

|Standard/Requirement |- Copy of current signed license (display copy). |

| |- Verification of current licensure. |

|Notes |- If the license expires after the application is in process, the copy of the license and PSV |

| |must be current when verification is confirmed complete. |

| |- Dates on the ID Number tab are not changed until the verification response is received. |

| |- State License is the PA license and the license for any other state where practicing. |

| |- One and only one license must be designated as primary. |

| |- A trainee license is not valid for hospital privileges. Do not enter on ID number screen and|

| |do not scan. |

| |- An institutional license is acceptable for some facilities. Request the letter. Verify from |

| |the State website. |

| |- An MD may have an acupuncturist (AK) license in addition to the MD license. Obtain copies |

| |and verify. |

| |- A DMD and DDS may have 2 licenses – dentist (DS) and dental anesthesia (DA or DP or DN). |

| |Obtain copies and verify both. |

A. Pennsylvania

|Preferred Verification |Webcrawl import of verification response from PA license verification website at |

|Source/Method | into scanned images. |

|Alternate Verification |Telephone verification. Call number as listed below and have the license number available. |

|Source/Method |Complete the verbal verification form and scan as the response. |

| |MD - (717) 783-1400 |

| |DO - (717) 783-4858 |

| |DMD/DDS - (717) 783-7162 |

| |DPM - (717) 783-4858 |

|Alternate Verification |Fax or mail verification. Print and fax the license verification letter to the PA Bureau of |

|Source/Method |Professional and Occupational Affairs Health Licensing Division at (717) 787-7769 or mail to |

| |the address listed below. No consent and release form is required. |

| | |

| |Commonwealth of Pennsylvania |

| |Department of State |

| |Bureau of Professional and Occupational Affairs |

| |Board of (appropriate Board) |

| |P.O. Box 2649 |

| |Harrisburg, PA 17105 |

B. Ohio

|Preferred Verification |MD, DO, DPM - Webcrawl import of verification response from Ohio license verification website |

|Source/Method |at state.oh.us/med into scanned images. |

| | |

| |DMD/DDS - Internet Grabber import of verification response from Ohio license verification |

| |website at dental. into scanned images. |

|Alternate Verification |No verbal verifications will be given. |

|Source/Method | |

|Alternate Verification |Mail requests with fee. No consent and release form is required. Print and send the license | |

|Source/Method |verification letter to | |

| | | |

| |The State of Ohio Medical Board | |

| |77 S. High Street | |

| |18th Floor | |

| |Columbus, OH 43266 | |

C. West Virginia

|Preferred Verification |Webcrawl import of verification response from WV license verification website at |

|Source/Method |wvbom/ into scanned images. |

|Alternate Verification |Verbal Verification. Complete the verbal verification form and scan. |

|Source/Method |MD - only three names per day to (304) 558-2921. |

| |DO – (304) 723-4638. |

| |DMD/DDS – (304) 252-8266. |

|Alternate Verification |MD, DPM – Mail requests with fee. No consent and release form is required. Print letter and |

|Source/Method |mail to |

| | |

| |West Virginia Board of Medicine |

| |101 Dee Drive |

| |Charleston, WV 25311 |

| | |

| |DMD/DDS – mail requests – no fee. No consent and release form is required. Print letter and |

| |mail to |

| | |

| |Dentists & Dental Hygienists, Board of Examiners |

| |P.O. Drawer 1459 |

| |Beckley, WV 25802-1459 |

| | |

| |DO – Mail requests with fee. No consent and release form is required. Print letter and mail |

| |to |

| | |

| |Board of Osteopathic Medicine |

| |334 Penco Road |

| |Weirton, WV 26062-3813 |

D. New York

|Preferred Verification |Webcrawl import of verification response from NY license verification website at |

|Source/Method |op.opsearches.htm into scanned images. |

|Alternate Verification |Mail requests with fee. No consent and release form is required. Print letter and mail|

|Source/Method |to |

| | |

| |New York State Education Department |

| |Office of the Professions |

| |State Education Building – 2nd Floor |

| |89 Washington Avenue |

| |Albany, New York 12234 |

II. Licensure Sanctions

|Standard/Requirement |Verification of license sanctions. |

|Preferred Verification |MD, DO – FSMB. Verification once per week via website at . Initiation of |

|Source/Method |verification process will initiate the request. Using Batch Update, a comment and date of |

| |query is entered on the ID Tab under the User Defined field. The task on the process must be |

| |manually completed. For information found, document to be scanned. Original FSMB reports on |

| |file for reference. |

| | |

| |DPM, DMD/DDS – direct from State Board (See license verification). |

III. DEA Certification

|Standard/Requirement |- Copy of current certificate. |

| |- Verification of current DEA certification. |

|Notes |- If the DEA expires after the application is in process, the copy of the DEA and PSV |

| |must be current when the verification is confirmed complete. (Unless the new DEA has |

| |just been obtained and the current DEA cannot be verified). |

| |-A DEA certificate and verification must be obtained for all states where practicing. |

| |- Dates on the ID Number tab are not changed until the verification response is |

| |received. |

|Preferred Verification |National Technical Information Service. Webcrawl import of verification response from |

|Source/Method |NTIS web site at into scanned images. |

|Alternate Verification |In an emergency situation, if the DEA number is known, Internet Grabber import of |

|Source/Method |verification response from |

| | |

| | |

| |Local office (412) 777-1870. |

IV. Board Certification

|Standard/Requirement |- Copy of current certificate or letter (if available) |

| |- Verification of current Board Certification. |

|Notes |- Recognized Boards only. Board certification from outside the USA is not recognized|

| |and not verified. |

| |- If the Board certification expires after the application is in process, the copy of |

| |the certificate and PSV must be current when the verification is confirmed complete. |

| |(Unless the new certification has just been obtained and the verification is not |

| |available on the Website.) |

| |- If a fee is indicated on the Specialty screen, place letter, consent/release and |

| |check request in the accounts payable box. If .99 is indicated in the fee field, follow|

| |the instructions in the comment field on the table screen. |

| |- Dates on the Specialty tab are not changed to reflect the current dates of the |

| |certification until the verification response is received. |

| |- If the certification does not expire, do not enter an expiration date, check the |

| |lifetime box. |

| |- If a copy of the Board certificate cannot be obtained after 2 attempts, the comment |

| |“requested 2 times – unable to obtain” is entered on the task and the task is |

| |completed. |

A. MD/DO

|Preferred Verification |ABMS CertiFACTS On-Line Verification. Webcrawl import of verification response from |

|Source/Method |ABMS web site at into scanned images. |

|Alternate Verification |Direct to Boards with approved verification. (Refer to verification sources policy) |

|Source/Method | |

B. DO

|Preferred Verification |American Osteopathic Association Physician Master File. Log onto the AOA website at |

|Source/Method |aoa-. Fee payable by credit card. Internet Grabber import of verification|

| |response. |

C. DPM

|Preferred Verification |American Board of Podiatric Surgery – Log onto the ABPS website at . Fee |

|Source/Method |payable by credit card. Internet Grabber import of verification response. |

| | |

| |American Board of Podiatric Medicine – Log onto the ABPM website at . Fee |

| |payable by credit card. |

| | |

| |American Board of Lower Extremity Surgery – verification by fax only. Print letter. Fax|

| |letter, attestation, and copy of certificate to (248) 855-7743. |

| | |

| |American Board of Multiple Specialties in Podiatry – call for verbal verification |

| |(888)852-1442. |

D. DMD/DDS

|Preferred Verification |American Board of Oral and Maxillofacial Surgery. Log onto the ABOMS website at |

|Source/Method |. Click on verification of certification status. Enter SS# of |

| |practitioner. If name does not display, written verification must be done. Fee payable |

| |by credit card. Internet Grabber import of verification response. |

| | |

| |American Board of Oral and Maxillofacial Pathology. Log onto the ABOMS website at |

| | to obtain verification. Fee payable by credit card. |

| | |

| |American Board of Pediatric Dentistry. Log onto the ABPD website at |

| | to obtain verification. Fee payable by |

| |credit card. |

| | |

| |American Board of Orthodontics. Log onto the ABO website at |

| |to obtain verification. Fee payable by credit card. |

V. Malpractice Insurance and History

|Standard/Requirement |- Copy of current malpractice insurance facesheet. |

| |- Verification of current malpractice insurance. |

| |- Verification of 10 year history of claims. |

|Notes |- Malpractice claims history is requested for 10 years if the practitioner graduated |

| |from the education/training program more than 10 years ago or the period beginning with|

| |graduation from the education/training program if the practitioner graduated less than |

| |10 years ago. |

| |- If the malpractice expires after the application is in process, the copy of the |

| |malpractice facesheet must be current when the verification is confirmed complete. The |

| |verification is not redone unless requested by the facility. |

| |- On expiration, dates on the Insurance tab are not changed to reflect the current |

| |dates of the insurance until the copy is received. When the copy is received, the |

| |dates on the malpractice tab and the image tab are updated. |

| |- All PSD practitioners working exclusively in PA must have Tri-Century insurance. |

| |Enter as the current insurance on the insurance screen even if not listed on the |

| |application. PSD practitioners working in both Ohio and PA will have Medical |

| |Protective Insurance. |

| |- The malpractice facesheet stating that it is only effective in the training program |

| |is not acceptable for hospital privileges. |

A. Tri-Century

|Preferred Verification |- Do not attempt to verify or request verification until the current facesheet is |

|Source/Method |obtained. |

| |- Once the facesheet is obtained, access the Tri-Century database. |

| |- If the verification for the practitioner is found, print the verification. If all 4 |

| |questions are answered “no”, scan the verification. If any question is answered “yes”, |

| |or if only two questions are answered, run the Tri-Century Request report and e-mail to|

| |the Tri-Century contact person. |

| |- If the verification for the practitioner is not found, run the Tri-Century Request |

| |report and e-mail to the Tri-Century contact person. |

| |- If 2 policies need to be verified, note in the subject line of the e-mail request. |

|Alternate Verification |- If the database cannot be used and the verification must be obtained immediately, run|

|Source/Method |the Tri-Century Request report and e-mail to the Tri-Century contact person with |

| |“urgent request” in the subject line. |

| |- If a second request letter is generated, run the Tri-Century Request report and |

| |e-mail to the Tri-Century contact person with “second request” in the subject line. |

| |- If there is no response to the second request, an e-mail is sent to the Tri-Century |

| |Coordinator indicating the dates of the previous requests and requesting an |

| |investigation. |

| |- The verifications for the last 6 months are available on the shared drive in the PSV |

| |Tri-Century folder |

B. Other Carriers

|Preferred Verification |- Print and send the request letter with a copy of the consent/release attached. |

|Source/Method |- If a fee is indicated on the Insurance screen, place letter, consent/release and |

| |check request in the accounts payable box. If .99 is indicated in the fee field, follow|

| |the instructions in the comment field on the table screen. |

|Alternate Verification |If first and second requests have been ignored or if needed immediately, fax the letter|

|Source/Method |with the consent/release attached. |

VI. Medical, Osteopathic, Podiatric or Dental Education

|Standard/Requirement |- Copy of certificate of completion. (If available). |

| |- Verification of completion. |

|Notes |- If verification previously done and in the scanned images, no additional verification|

| |is necessary. Link the verification response to the image response tab. |

| |- If a fee is indicated on the Credentials screen, place letter, consent/release and |

| |check request in the accounts payable box. If .99 is indicated in the fee field, follow|

| |the instructions in the comment field on the table screen. |

| |- For University of Pittsburgh programs, print the letter, attach the consent/release |

| |and place in the appropriate mail bin. |

| |- A copy of the medical school diploma is requested with the first and second missing |

| |letters. If still unable to obtain, the task may be completed without the certificate.|

A. MD

|Preferred Verification |US Medical School (including Canada and Puerto Rico) – print and send letter to |

|Source/Method |institution with copy of consent/release attached. |

| | |

| |Foreign Medical School - print and send letter to institution with copy of |

| |consent/release attached. If no response after 2 attempts and ECFMG is verified, no |

| |additional attempts are necessary. Link the verification response of Foreign |

| |Education/Training document from O to the response image tab. The comment “ECFMG” is |

| |entered. |

| | |

| |Access the ECFMG Website at and follow the directions on the screen. |

|Alternate Verification |AMA Physician Master File – log onto the website at amaprofiles to |

|Source/Method |request a profile. Fee payable by credit card. Must purchase a report for each |

| |facility. The report is not sharable. Report can be view in 5 minutes to 24 hours. |

| |Internet Grabber import of verification response. For questions or problems, phone |

| |1-800-665-2282. If comment “being reverified” is on the report, the verification |

| |cannot be used and must be requested. |

| | |

| |US Medical School – . Log onto the Degreeverify website. Internet |

| |Grabber import of verification response. A .99 in the fee field will indicate a |

| |comment on the table entry. Do not send letter. School will not verify. |

| | |

| |Foreign Medical School – If the practitioner indicates that they have a FCVS report, |

| |ask the physician to have FCVS send a sealed official copy addressed directly to the |

| |CVO. An unsealed copy sent by the physician is not acceptable as verification. |

B. DO

|Preferred Verification |Print and send letter to institution with consent/release attached. |

|Source/Method | |

|Alternate Verification |AOA Physician Master File - Internet Grabber import of verification response from the |

|Source/Method |web site at aoa-. |

| | |

| |Foreign Medical School – If the practitioner indicates that they have a FCVS report, |

| |ask the physician to have FCVS send a sealed official copy addressed directly to the |

| |CVO. An unsealed copy sent by the physician is not acceptable as verification. |

C. DMD/DDS

|Preferred Verification |Print and send letter to institution with consent/release attached. |

|Source/Method | |

D. DPM

|Preferred Verification |Print and send letter to institution with consent/release attached. |

|Source/Method | |

VII. Training Programs

|Standard/Requirement |- Copy of certificate of completion. |

| |- Verification of completion of internship, residency and fellowship programs. All |

| |begun and/or completed must be verified. |

|Notes |- For residency or fellowship, if less than 5 years since graduation, a program |

| |director evaluation must be obtained. If the verification is returned without the |

| |evaluation, enter the program director as a program director evaluation in the peer |

| |references tab and send the letter with the consent/release attached. If the Program |

| |Director Evaluation includes verification of dates of training, it may also be used as |

| |verification of training. For University of Pittsburgh programs, request the program |

| |director evaluation when the process is initiated. |

| |- The copy of the certificate of completion is requested in the first and second |

| |missing letters. If still unable to obtain, the task may be completed without the |

| |certificate. |

| |- If verification previously done and in the scanned images, no additional verification|

| |is necessary. Link the verification response to the image response tab. |

| |- If foreign program has been completed, 2 attempts will be made to obtain |

| |verification. No additional attempts will be made if a two-year residency has been |

| |completed in the USA. Link the verification response of Foreign Education/Training |

| |document from O to the response image tab. The comment “foreign rule” is entered. |

| |- If a fee is indicated on the Credentials screen, place letter, consent/release and |

| |check request in the accounts payable box. If .99 is indicated in the fee field, follow|

| |the instructions in the comment field on the table screen. |

| |- For University of Pittsburgh programs, print the letter, attach the consent/release |

| |and place in the appropriate mail bin. |

| |- If currently in training and verification of completion of the program is the last |

| |item needed, the process can be completed. |

A. MD

|Preferred Verification |Print and send letter to institution with consent/release attached. |

|Source/Method | |

|Alternate Verification |AMA Physician Master File – log onto the website at amaprofiles to |

|Source/Method |request a profile. Fee payable by credit card. Must purchase a report for each |

| |facility. The report is not sharable. Report can be view in 5 minutes to 24 hours. |

| |Internet Grabber import of verification response. For questions or problems, phone |

| |1-800-665-2282. If comment “being reverified” is on the report, the verification |

| |cannot be used and must be requested. |

| | |

| |US Medical School – . Log onto the Degreeverify website. Internet |

| |Grabber import of verification response. A .99 in the fee field will indicate a |

| |comment on the table entry. Do not send letter. School will not verify. |

| | |

| |Foreign Medical School – If the practitioner indicates that they have a FCVS report, |

| |ask the physician to have FCVS send a sealed official copy addressed directly to the |

| |CVO. An unsealed copy sent by the physician is not acceptable as verification. |

B. DO

|Preferred Verification |Print and send letter to institution with consent/release attached. |

|Source/Method | |

|Alternate Verification |AOA Physician Master File - Internet Grabber import of verification response from the |

|Source/Method |web site at aoa-. |

| | |

| |US Medical School – . Log onto the Degreeverify website. Internet |

| |Grabber import of verification response. A .99 in the fee field will indicate a |

| |comment on the table entry. Do not send letter. School will not verify. |

| | |

| |Foreign Medical School – If the practitioner indicates that they have a FCVS report, |

| |ask the physician to have FCVS send a sealed official copy addressed directly to the |

| |CVO. An unsealed copy sent by the physician is not acceptable as verification. |

C. DDS/DMD

|Preferred Verification |Print and send letter to institution with consent/release attached. |

|Source/Method | |

|Alternate Verification |US Dental School – . Log onto the Degreeverify website. Internet |

|Source/Method |Grabber import of verification response. A .99 in the fee field will indicate a |

| |comment on the table entry. Do not send letter. School will not verify. |

D. DPM

|Preferred Verification |Print and send letter to institution with consent/release attached. |

|Source/Method | |

|Alternate Verification |US Podiatric School – . Log onto the Degreeverify website. |

|Source/Method |Internet Grabber import of verification response. A .99 in the fee field will |

| |indicate a comment on the table entry. Do not send letter. School will not verify. |

VIII. Hospital Affiliations

|Standard/Requirement |Verification of hospital affiliations for the past 10 years or 10. (unless required to |

| |verify a gap in professional activities and work history) |

|Notes |- Hospital affiliation is not verified for facilities where the practitioner is |

| |applying. Although indicated on the front of the CIF, the facility is not entered as an|

| |affiliation until the practitioner status is changed to an active status (active, |

| |interim, provisional). |

| |- A roster may not be used to verify an initial Medical Staff application unless the |

| |cover letter clearly states that a response to an individual request will not be sent. |

| |- Online verifications can be obtained from participating UPMC hospitals by accessing |

| |the UPMC psv website. |

| |- If a fee is indicated on the Hospitals screen, place letter, consent/release and |

| |check request in the accounts payable box. If .99 is indicated in the fee field, follow|

| |the instructions in the comment field on the table screen. |

| |- A list of facilities requiring a stamped return envelope is posted by the mailing |

| |desk. |

| |- Check Hospitals screen for requests that are e-mailed. |

| |- Do not reverify prior hospital affiliations if a thru date has been entered and a |

| |verification obtained previously is linked. |

| |- Moonlighting affiliations are verified. |

| |- Urgent care facilities are entered as offices and are not verified. |

|Preferred Verification |- Whenever possible, E-mail the letter to the facility with consent/release attached. |

|Source/Method |- Print and mail letter to the facility with consent/release attached. |

|Alternate Verification |Print and fax the letter and consent/release to the facility. |

|Source/Method | |

X. Professional Activities and Work History

|Standard/Requirement |Verification of work history for physicians is usually not obtained. However, work |

| |history verification for a physician is obtained to verify a gap that cannot be |

| |otherwise verified. |

|Notes |- All entries on the Professional Activities and Work History chronology are to be |

| |entered on the Work History screen unless already entered on the credentials or |

| |hospitals screen. |

| |- A gap analysis is done. Any gap of greater than 3 months must have an explanation. |

|Preferred Verification |If employment is to be verified to verify a gap, add the task to the process, print and|

|Source/Method |send a letter with the consent/release attached to the employer. |

X. Military Service

|Standard/Requirement |Verification of military service within the past 10 years. (unless required to verify a|

| |gap in professional activities and work history) |

|Preferred Verification |Print and mail letter to the institution with consent/release attached. |

|Source/Method | |

|Alternate Verification |Request a copy of the Physicians Discharge Papers (DD214). |

|Source/Method | |

| |Print and mail the letter to |

| | |

| |Military Records Center (for most verifications) |

| |9700 Page Boulevard |

| |St. Louis, MO 63132 |

| | |

| |See information on CVO Shared Drive for addresses applicable to other specific military|

| |circumstances. |

XI. Teaching Appointments (or academic appointments or faculty appointments)

|Standard/Requirement |Verification of current teaching appointment. (Prior teaching appointments are not |

| |verified unless required to verify a gap in professional activities and work history) |

|Notes |- Only the current appointment is verified. |

| |- Every active/active physician at PUH is required to have a teaching appointment. Even|

| |if not listed on the application or CV, enter a teaching appointment and verify. |

| |- Every Pitt teaching appointment should have an expiration date according to the |

| |verification received. If the date on the verification is expired by more than one |

| |year, make the teaching appointment prior. |

| |- If a verification is needed outside of the verification process, forward to the Lead |

| |Credentialing Coordinator. |

|Preferred Verification |Print and mail letter to the reference with the confidential peer evaluation form and |

|Source/Method |the consent/release attached |

|Alternate Verification |Print and fax letter to the reference with the confidential peer evaluation form and |

|Source/Method |the consent/release attached |

|Alternate Verification |E-mail the letter to the reference with the confidential peer evaluation form and the |

|Source/Method |consent/release attached |

A. University of Pittsburgh

|Preferred Verification |MD/DO - Send letter to Physician Services Division (41206) first to verify all UPMC |

|Source/Method |facility appointments. If no response, send to University of Pittsburgh (2463). If no |

| |response, send to the specific facility. Mail bins are to be used for PSD & Pitt |

| |requests. |

| | |

| |DMD - Send letter to with consent/release attached to |

| |University of Pittsburgh |

| |School of Dental Medicine |

| |420 Salk Hall |

| |Pittsburgh, PA 15261 |

|Alternate Verification |Call (412) 648-2030 and complete verbal verification letter on the CVO Shared Drive |

|Source/Method | |

XII. Peer References

|Standard/Requirement |Verification of 3 peer references. |

|Notes |- A peer is defined as having the same education/degree as the applicant (MD and DO are|

| |equivalent). |

| |- Reference must have worked directly with the applicant in the last 24 months. If a |

| |peer reference does not meet the requirement, a new peer reference must be requested. |

| |(The question must be answered on the reference form.) |

| |- At least one peer must be from the same specialty. |

| |- All questions must be answered individually, completely and explanations included for|

| |any Fair or Poor responses. |

| |- The peer references listed on the application must be obtained. If a reference is to |

| |be substituted (practitioner out of country, unavailable, etc), the reason for the |

| |substitution must be documented. The documentation is to be scanned as peer reference |

| |specified. If the application is received with no references listed, the names and |

| |addresses must be documented when obtained and scanned as peer reference specified. |

| |- A picture of the applicant is attached to each verification request sent. |

| |- If a reference previously obtained is no more than 3 months old on the day the |

| |application is processed, and includes the photo recognition question, the reference |

| |does not need to be requested again. |

| |- If a reference is received that contains information of a sensitive or confidential |

| |nature, it is to be e-mailed to the Medical Staff Coordinator(s) directly as a priority|

| |e-mail with the subject “urgent confidential matter”. A document is scanned into images|

| |stating that due to the sensitive or confidential nature of the information that it was|

| |e-mailed directly to the facilities instead of scanned into images. |

|Preferred Verification |Print and mail letter to the reference with the confidential peer evaluation form and |

|Source/Method |the consent/release attached |

|Alternate Verification |Print and fax letter to the reference with the confidential peer evaluation form and |

|Source/Method |the consent/release attached |

|Alternate Verification |E-mail the letter to the reference with the confidential peer evaluation form and the |

|Source/Method |consent/release attached |

XIII. Clinical Competence Evaluation

|Standard/Requirement |Verification of clinical competence |

|Notes |The evaluation is sent to the practitioner listed on the Competence Designation Form. A|

| |peer reference and/or Program Director evaluation should not be sent to the |

| |practitioner designated for the competence evaluation. |

| |The competence evaluation is entered as a peer reference. |

| |The verification method must be letter (print). |

| |If the practitioner does not have a Privilege Form, then a competence evaluation is not|

| |required. Delete the task from the process. |

|Preferred Verification |Print and mail letter to the designated practitioner with the competence evaluation |

|Source/Method |form, the consent/release and the privilege form attached |

|Alternate Verification |Print and fax letter to the designated practitioner with the competence evaluation |

|Source/Method |form, the consent/release and the privilege form attached |

|Alternate Verification |E-mail the letter to the designated practitioner with the confidential peer evaluation |

|Source/Method |form, the consent/release and the privilege request attached |

| | |

| |Print the letter with the evaluation form and consent attached |

| |Scan into images as A CVO Request |

| |Use combined images to create a pdf to send – sequence the letter first – the DOP |

| |Request second |

| |Click on the combined image and create an e-mail to send |

XIV. Medicare/Medicaid Sanctions

|Standard/Requirement |Verification of Medicare/Medicaid sanctions. |

|Preferred Verification |Office of the Inspector General. Webcrawl import of verification response from OIG web |

|Source/Method |site at \home.html into scanned images. If there is a name|

| |match, search by SS# to confirm there is no match, print, sign and scan the letter from|

| |the OIG Query task. |

XV. Criminal Background Checks

|Standard/Requirement |Criminal background check including social security number trace and 7 year history of |

| |criminal convictions. |

|Notes |- Must have signed authorization prior to requesting. If a facility requests a CBC |

| |outside of a current process, the facility must obtain and supply the CVO with the CBC |

| |Authorization. |

| |- The CBC is obtained only once. If obtained previously and the report is in the |

| |scanned images, check the item off as complete on the task list. The CBC can be redone|

| |on an initial application if requested by a facility and the authorization has been |

| |signed. |

|Preferred Verification |- Request to be sent via e-mail from the drop down reports on the practitioner task |

|Source/Method |list. E-mail request to documentation@. The task CBC Request Sent is |

| |completed after the “request submitted” e-mail is received from Hireright. When the |

| |report is completed, Hireright notifies the requestor via e-mail. The completed report|

| |can be accessed by clicking on the link contained in the email or by accessing |

| |. Download and Open (do not just print) the report. |

| |Review the grid on page 1 of the report. If the grid displays Data Found on the SS |

| |Trace only, scan the report and complete the task. If the grid says Data Found for any|

| |other product, give the report to the Lead Coordinator or designee to clarify the |

| |results before scanning and completing the task. |

| |- The Act 34 PATCH report is received by the CBC requestor in a separate email from |

| |Hireright for any practitioner with a PA address. The subject of the email will read: |

| |Healthcare Statewide Criminal Results. The attachment is to be printed and scanned as |

| |Act 34 PATCH. Because this is direct from the verification source, the original |

| |document does not need to be witnessed. |

| |- For customer service issues, e-mail customerservice@ |

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