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|Credentials Verification Office | |

| |Section |Policy |

| |IV |6 |

| |

|TITLE: CVO Process Initiation and Documentation |

| |

|Date of Implementation: October, 2005 |

|Revised: 9/06; 11/17/06; 11/17/07; 12/07; 11/08 |

|2/1/09; 11/1/09; 2/23/10; 11/10; 11/11; |

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

| | Signed Original on File at the CVO Office |

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

CVO processes are initiated and completed according to specific guidelines the following are the general types of processes available:

• Application Requested/Initiated/Received

• Verification

• Mini Verification

• Reverification

• Expirables

• Quality Improvement

In addition to specific guidelines for each process, the following are general guidelines applicable to all processes:

• To initiate a process for one practitioner,

o Select the practitioner

o On the Staff screen, click on the green + next to Active Processes:

o Choose a Process

o Find a facility (usually all)

o Enter T for today

o Click the green Go button at the top left of the screen

o Click OK

o Refresh the screen

• To initiate a process for more than one practitioner,

o Access the file menu/workflow/EWL

o Click on the blue Start Process button at the top of the screen

o Select each practitioner or access the Criteria tab

o Click the ALL button so all practitioners can be accessed via a scroll bar

o Choose a Process

o Find a facility (usually all)

o Enter T for today

o Click the green Go button at the top left of the screen

o Click OK

o Refresh the screen

• For each active process, a practitioner task list graph is visible in the Process section of the screen and the process code is visible on the Facilities grid. Completed processes are available for viewing via the process archive.

• Only the facilities linked to the process (the process code can be seen in the facilities grid for the facility) will have access to view the practitioner task list graph.

• To link a facility to a process already initiated, select that facility in the Initiate Process dropdown.

Note: the notification e-mails will not be sent – the facility must be notified via a manually generated e-mail.

• Data entry of additional information on the Staff blue button screens will generate a task on all active processes containing a task related to that information. (Example – entering a peer reference for a reapplication verification process will create a peer reference task on an initial verification process that is active – even if verification is complete. Example – entering a hospital affiliation for a PEC/PHO verification process will create a hospital affiliation task on an initial verification or reapplication verification process.) Tasks not applicable to the process are deleted. Deleting the task deletes the message on the EWL and the letter if generated.

• Tasks are individually completed by entering a date and user name on the right side of the process screen and clicking the task save button directly above.

• Tasks are batch completed by checking the box in front of the task on the left side of the process screen and clicking the save button at the top of the screen.

• Completion of tasks when multiple processes are active is dependent on the screen where the task is completed.

o Tasks completed from the blue button task tab will complete all other active process tasks for the same document.

o Tasks individually completed from the practitioner task list will complete all other active process tasks for the same document.

o Tasks batch completed from the practitioner task list will only complete the task in that process.

• A document and/or response image may be required prior to task completion.

• For the State License and DEA Number, the Webcrawler automatically completes the verification. If there are no errors and the document is linked, the expiration date is automatically updated and the task is automatically completed.

• For the Specialties Board, the Webcrawler automatically completes the verification but it does not complete the task.

• For the OIG Query, the Webcrawler automatically completes the verification. If there are no errors and the document is linked, the task is automatically completed.

• For the Confirm Verification Complete task, the person listed in the Assigned To: field is the CVO staff member responsible to complete the verification of the application.

• Action for most tasks can be changed from the task list, i.e. from letter (print) to letter (e-mail) or letter (fax). Also, never change the action to Internet Grabber.

The guidelines for each process are documented on the following pages. Tasks that are self explanatory and the completion of tasks that are required are listed but may not have any additional comments.

Application Requested/Initiated/Received Processes

CVO Initial Application Requested CVOAppReq

• Initiated: on receipt of an application request

• Initiated by: Director, Lead Credentialing Coordinator or Designee

• Initiated for: any facility where the practitioner status is Preapplication

• Completed: when the verification initiated task is complete

|Job and Task |Comment |

| | |

|Initial Application Tracking | |

| Request Received |Enter date request received. |

| Application Sent |On process initiation, e-mail notification to facility automatically |

| |sent and task completed. |

| | |

| |If e-mailed, enter the e-mail address and requestor. |

| Application Received |Enter date the Medical Staff initial application received. Completion |

| |of task completes job and launches verification initiated job. |

| | |

| |If unable to process application or if application is resent, enter a |

| |comment on the task but do not complete the task. |

|Verification Initiated |Enter date verification initiated. Completion of task completes the job|

| |and the process. |

CVO Initial Application Received CVOAppRecv

• Initiated: on receipt of a Medical Staff initial application when there is no active CVO initial application requested process

• Initiated by: Credentialing Assistant

• Initiated for: CVO facility – practitioner status active

• Completed: when the verification initiated task is complete

|Job and Task |Comment |

| | |

|Initial Application Tracking | |

| Application Received |Enter date the Medical Staff initial application received. |

| Verification Initiated |Enter date verification initiated. Completion of task completes job and|

| |process. |

CVO PEC/PHO Application Received CVOphoRecv

• Initiated: on receipt of a Managed Care credentialing application

• Initiated by: Credentialing Assistant

• Initiated for: PEC or PHO facility – practitioner status applicant

• Completed: when the verification initiated task is complete

|Job and Task |Comment |

| | |

|Initial PEC/PHO Application Tracking | |

| PEC/PHO Application Received |Enter date the managed care credentialing application received. |

| PEC/PHO Verification Initiated |Enter date verification initiated. Completion of task completes job and|

| |process. |

CVO Reapplication Initiated – on paper CVOreapInt

• Initiated: to begin the system reappointment process for the month

• Initiated by: Director

• Initiated for: all facilities where the practitioner status is active

• Completed: when the reapplication is received and the verification initiated task is complete

|Job and Task |Comment |

| | |

|Reapplication Tracking | |

| Reapplication Sent |Completed on process initiated. Reapplications generated and available|

| |on EWL to print (CVOReapInt). |

| Reapplication Received |Enter date reapplication received. |

| | |

| |If unable to process reapplication or if reapplication is resent, enter|

| |a comment on the task but do not complete the task. |

|Verification Initiated |Enter date verification initiated. Completion of task completes the job|

| |and the process. |

CVO Reapplication Initiated - online CVOreIntMD or CVOreInAHP

• Initiated: to begin the system reappointment process for the month

• Initiated by: Director

• Initiated for: all facilities where the practitioner status is active

• Completed: when the reapplication is received and the verification initiated task is complete

|Job and Task |Comment |

| | |

|Reapplication Tracking | |

| Reapplication Sent |Completed on process initiated. Notification e-mails sent for online |

| |access (CVOIntMD and CVOIntAHP). |

| Reapplication Received |Enter date reapplication received. |

| | |

| |If unable to process reapplication or if reapplication is resent, enter|

| |a comment on the task but do not complete the task. |

|CIF Imported | |

| Reapp CIF Available in Images |Complete after CIF is imported and posted to images |

|Verification Initiated |Enter date verification initiated. Completion of task completes the job|

| |and the process. |

Note that the following two processes are no longer used:

• CVOReIntMD CVO Reapp Initiated MD (old)

• CVOReIntAHP CVO Reapp Initiated AHP (old)

Verification Processes

CVO Med Staff MD App CVOmsMDApp

• Initiated: to begin the verification process for a Medical Staff initial application for a physician (MD, DO, DPM, DMD)

• Initiated by: Credentialing Coordinator

• Initiated for: all facilities where the practitioner status is one in the applicant status group – usually preapplication or applicant

• Completed: 6 months after verification is confirmed complete or when the facility status for all facilities has been changed to a status in the inactive status group

|Job and Task |Comment |

| | |

|Facility Notification | |

| Application In Process |On process initiation, e-mail notification automatically sent to all |

| |facilities and task is automatically completed. |

|Application | |

| All Pages Complete | |

| Peer References Specified | |

| Details 3 Month Gap |If no gap, delete task. |

| Declaration Question explanation |If no yes answers, delete task. |

| Malpractice Explanation |If no yes answers, delete task. |

| Board Certification Explanation |If Board certified, delete the task. |

| Application Fee Paid |Task is added to the process when a star on the front of the |

| |application indicates that the application fee has not been paid. |

| Other Missing Information |If no information missing, delete task. |

|Documents | |

| Consent and Release Form | |

| Physician Activity Profile | |

| Competence Designation | |

| DOP Request Form | |

| Physician Acknowledgement Statement | |

| CBC Authorization | |

| CV | |

| CME Credits |If CME credits are not needed, delete task. |

| PPD Results | |

| Photograph | |

|Verify Licensure/Certification | |

| State License | |

| State License Pending |Task is added to the process only if the practitioner has a State |

| |License and the PA State License is pending. |

| DEA License |If practitioner does not have a DEA and never will have a DEA, delete |

| |the task. |

| DEA License Pending |Task is added to the process only if the practitioner has a DEA (not |

| |historical) and the PA DEA is pending. |

| Controlled Substance License |Task is added to process if Controlled Substance License is to be |

| |verified. |

| Board Certification |If not certified by a recognized board, delete the task. |

|OIG Query | |

| OIG Query | |

|FSMB Query | |

| FSMB Query Request |When FSMB Query request is sent, task is automatically completed. |

| FSMQ Query Report |Task is completed when the FSMB Query results are available on the ID |

| |numbers user defined screen. |

|CBC Report | |

| CBC Request Sent |Task is completed when th e-mail confirming receipt of the request is |

| |received. |

| CBC Report Received |Task is complete when the CBC Report is available in scanned images. |

|Verify Education | |

| Medical Education | |

| ECFMG Request |Task is deleted if practitioner does not have an ECFMG number. |

| ECFMG Report |Task is deleted if practitioner does not have an ECFMG number. |

| Internship | |

| Residency | |

| Fellowship | |

| AMA Profile |Task is added to process if AMA profile is obtained. |

| FCVS Report |Task is added to process if FCVS report is received. |

| Additional Education |Task is added to process when necessary. |

| Externship |Task is added to process when necessary. |

| Research Fellowship |Task is added to process when necessary. |

| Fifth Pathway |Task is added to process when necessary. |

|Verify Teaching Appointment | |

| Teaching Appointment Current | |

| Teaching Appointment Prior |Task is added to process if needed to verify a gap. |

|Verify Malpractice Insurance | |

| Malpractice Insurance Current | |

| Malpractice Insurance Prior | |

| Malpractice Insurance Pending |Task is added to the process only if the practitioner has current |

| |malpractice and a different malpractice carrier is pending (usually |

| |Tri-Century) |

|Verify Hospital Affiliations | |

| Hospital Affiliations Current | |

| Hospital Affiliations Prior | |

|Verify References | |

| Peer References | |

| Competence Evaluation | |

| Program Director Evaluation |Task is added to process if the Program Director evaluation is not |

| |completed on the education verification. |

|Verify Work History | |

| Work History Current |Job/Task is added to process if needed to verify a gap. |

| Work History Prior |Job/Task is added to process if needed to verify a gap. |

|Verify Military Service | |

| Military Service |Job/Task is added to process if military service to be verified. |

|Incomplete Application Review | |

| Application Review |Enter date of next application review in the RVW date field. Task is |

| |not completed until verification is confirmed complete. |

|File on Hold | |

| File on Hold |Job/Task is added to the process if all tasks are complete except State|

| |License, DEA and/or malpractice. |

|Validate Completed Items | |

| Run Validate Report |Task is completed after report is run and before verification is |

| |confirmed complete. |

|Verification Complete | |

| Confirm Verification Complete |Task is completed once verification has been confirmed complete. |

|Facility Notification | |

| Verification Complete |Once confirm verification complete task is completed, automatic e-mail |

| |is sent to all facilities and task is completed. |

|Process Complete | |

| Close Process |Once facility notification task is completed, task appears. The task is|

| |not completed until 6 months after verification is confirmed complete. |

| |The CVO director completes this task. |

|Discrepancy Letter | |

| Discrepancy Letter |Job/Task is added to process if discrepancy letter is needed. Task is |

| |not completed until the discrepancy is resolved. |

|Missing Item Letters | |

| Missing Items Letter |Job/Task is added to process if missing items letter is needed. Task |

| |is completed once verification has been confirmed. |

| Missing Items – Second Request |Job/Task is added to process if missing items letter is needed. Task |

| |is completed once verification has been confirmed. |

| Missing Items – Certified Letter |Job/Task is added to process if missing items letter is needed. Task |

| |is completed once verification has been confirmed. |

CVO Med Staff AHP App CVOmsAHApp

• Initiated: to begin the verification process for a Medical Staff initial application for an Allied Health Practitioner (AHP)

• Initiated by: Credentialing Coordinator

• Initiated for: all facilities where the practitioner status is preapplication or applicant

• Completed: 6 months after verification is confirmed complete or when the facility status for all facilities has been changed to a status in the inactive status group

|Job and Task |Comment |

| | |

|Facility Notification | |

| Application In Process |On process initiation, e-mail notification automatically sent to all |

| |facilities and task is automatically completed. |

|Application | |

| All Pages Complete | |

| References Specified | |

| Details 3 Month Gap |If no gap, delete task. |

| Declaration Question Explanation |If no yes answers, delete task. |

| Malpractice Explanation |If no yes answers, delete task. |

| Application Fee Paid |Task is added to the process when a star on the front of the |

| |application indicates that the application fee has not been paid. |

| Other Missing Information |If no information missing, delete task. |

|Documents | |

| Consent and Release Form | |

| Competence Designation | |

| CSOP Request Form | |

| Supervising Physician Letter |Task is added to process for PA-C. |

| CBC Authorization | |

| CV | |

| CME Credits | |

| PPD Results | |

| Photograph | |

|Verify Licensure/Certification | |

| State License | |

| State License Pending |Task is added to the process only if the practitioner has a State |

| |License and the PA State License is pending. |

| DEA License |Task is added to process if DEA License is to be verified. |

| DEA License Pending |Task is added to the process only if the practitioner has a DEA (not |

| |historical) and the PA DEA is pending. |

| Controlled Substance License |Task is added to process if Controlled Substance License is to be |

| |verified. |

| Certification |If not certified, the task is deleted. |

| Prescriptive Authority |Task is added to the process if Prescriptive Authority is to be |

| |verified |

|OIG Query | |

| OIG Query | |

|FSMB Query | |

| FSMB Query Request |Job is added to process for PA-C. When FSMB query request is sent, task|

| |is automatically completed. |

| FSMB Query Report |Job is added to process for PA-C. Task is completed when FSMB query |

| |results are available on the ID numbers user defined screen. |

|CBC Report | |

| CBC Request Sent |Task is completed when the e-mail confirming receipt of the request is |

| |received. |

| CBC Report Received |Task is completed when the CBC Report is available in scanned images. |

|Verify Education | |

| Undergraduate Education | |

| Post Graduate Education | |

| Additional Training | |

| FCVS Report |Task is added to process if FCVS Report received. |

|Verify Teaching Appointment | |

| Teaching Appointment Current | |

| Teaching Appointment Prior |Task is added to process if needed to verify a gap. |

|Verify Malpractice Insurance | |

| Malpractice Insurance Current | |

| Malpractice Insurance Prior |Task is added to the process only if there are prior claims or the |

| |Medical Staff Office requests verification. |

| Malpractice Insurance Pending |Task is added to the process only if the practitioner has current |

| |malpractice and a different malpractice carrier is pending (usually |

| |Tri-Century) |

|Verify Hospital Affiliations | |

| Hospital Affiliations Current | |

| Hospital Affiliations Prior | |

|Verify References | |

| Peer References | |

| Competence Evaluation | |

| Character References | |

|Verify Work History | |

| Work History Current | |

| Work History Prior | |

|Verify Military Service | |

| Military Service |Job/Task is added if Military Service to be verified. |

|Incomplete Application Review | |

| Application Review |Enter date of next application review in the RVW date field. Task is |

| |not completed until verification is confirmed complete. |

|Validate Completed Items | |

| Run Validate Report |Task is completed after report is run and before verification is |

| |confirmed complete. |

|Verification Complete | |

| Confirm Verification Complete |Task is completed once verification has been confirmed complete. |

|File on Hold | |

| File on Hold |Job/Task is added to the process if all tasks are complete except State|

| |License, DEA and/or malpractice. |

|Facility Notification | |

| Verification Complete |Once confirm verification complete, automatic e-mail is sent to all |

| |facilities and task is completed. |

|Process Complete | |

| Close Process |Once facility notification task is completed, task appears. The task |

| |is not completed until 6 months after verification is confirmed |

| |complete. The CVO director completes this task. |

|Discrepancy Letter | |

| Discrepancy Letter |Job/Task is added to process if discrepancy letter is needed. The task |

| |is not completed until the discrepancy is resolved. |

|Missing Items Letters | |

| Missing Items Letter |Job/Task is added to process if missing items letter is needed. Task |

| |is completed once verification has been confirmed. |

| Missing Items – Second Request |Job/Task is added to process if missing items letter is needed. Task |

| |is completed once verification has been confirmed. |

| Missing Items – Certified Letter |Job/Task is added to process if missing items letter is needed. Task |

| |is completed once verification has been confirmed. |

CVO MD Reapplication CVOReappMD

• Initiated: to begin the verification process for a system reapplication for a physician (MD, DO, DPM, DMD)

• Initiated by: Credentialing Coordinator

• Initiated for: all facilities where the practitioner status is one in the active status group – most frequently active or provisional

• Completed: 6 months after the system reapplication date or when the facility status for all facilities has been changed to a status in the inactive status group

|Job and Task |Comment |

| | |

|Facility Notification | |

| Reapplication In Process |On process initiation, e-mail notification automatically sent to all |

| |facilities and task is automatically completed. |

|Reapplication | |

| All Pages Complete | |

| Peer References Specified | |

| Details 3 Month Gap |If no gap, delete task. |

| Declaration Question |If no yes answers, delete task. |

|Explanation | |

| Malpractice Explanation |If no yes answers, delete task. |

| Board Certification Explanation |If Board certified, delete the task. |

| Other Missing Information |If no information missing, delete task. |

|Documents | |

| Reapp Consent and Release | |

| Physician Activity Profile |Task is deleted if not UPP anesthesiology, emergency medicine, |

| |pathology or radiology. |

| DOP Request Form |Use when submitted on paper. Delete task if submitted online. |

| Privilege Request Form |Use when submitted online. Delete task if submitted on paper. Document|

| |comment must read “Privilege Request DOP” Document does not link to |

| |task. |

| Reapp Attestation |Task is deleted if not received and not PEC/PHO. |

| CBC Authorization |Task is added to the process if a CBC Report is needed. |

| CV | |

| CME Credits | |

| PPD Results | |

| Photograph | |

|Verify Licensure/Certification | |

| State License | |

| DEA License |If practitioner does not have a DEA and never will have a DEA, delete |

| |the task. |

| DEA License Pending |Task is added to the process only if the practitioner has a DEA (not |

| |historical) and the PA DEA is pending. |

| Controlled Substance License |Task is added to process if Controlled Substance License is to be |

| |verified. |

| Board Certification |If not certified by a recognized board, the task is deleted. |

|OIG Query | |

| OIG Query | |

|FSMB Query | |

| FSMB Query Request |Job is added only if requested. When FSMB Query request is sent, task |

| |is automatically completed. |

| FSMQ Query Report |Job is added to process only if requested. Task is completed when the |

| |FSMB Query results are available on the ID numbers user defined screen.|

|CBC Report | |

| CBC Request Sent |Delete task if CBC Report previously received. |

| CBC Report Received | |

|Verify Teaching Appointment | |

| Teaching Appointment Current | |

| Teaching Appointment Prior |Task is added to process if needed to verify a gap. |

|Verify Malpractice Insurance | |

| Malpractice Insurance Current | |

| Malpractice Insurance Prior |Verify only if within the previous 2 years. Change document name to |

| |malpractice insurance prior reapp. |

|Verify Hospital Affiliations | |

| Hospital Affiliations Current | |

|Verify References | |

| Peer References | |

|Verify Work History | |

| Work History |Task is added to process if needed to verify a gap. |

|Verify Military Service | |

| Military Service |Job/Task is added to process if military service to be verified. |

|Incomplete Reapplication Review |Enter date of next reapplication review in the RVW date field. Task is |

| |not completed until verification is confirmed complete. |

|Validate Completed Items | |

| Run Validate Report |Task is completed after report is run and before verification is |

| |confirmed complete. |

|Verification Complete | |

| Confirm Verification Complete |Task is completed once verification has been confirmed complete. |

|Facility Notification | |

| Verification Complete |Once confirm verification complete task is completed, automatic e-mail |

| |is sent to all facilities and task is completed. |

|Process Complete | |

| Close Process |Once facility notification task is completed, task appears. The task is|

| |not completed until 6 months after the system reapp date. The CVO |

| |director completes this task. |

|Discrepancy Letter | |

| Discrepancy Letter |Job/Task is added to process if discrepancy letter is needed. The task |

| |is not completed until the discrepancy is resolved. |

|Reapp Missing Item Letters | |

| Reapp Missing Items Letter |Job/Task is added to process if missing items letter is needed. Task |

| |is completed once verification has been confirmed. |

| Reapp Missing Items – Second Request |Job/Task is added to process if missing items letter is needed. Task |

| |is completed once verification has been confirmed. |

| Reapp Missing Items – Certified Letter |Job/Task is added to process if missing items letter is needed. Task |

| |is completed once verification has been confirmed. |

CVO AHP Reapplication CVOReappAH

• Initiated: to begin the verification process for a system reapplication for an Allied Health Practitioner (all practitioners except MD, DO, DPM and DMD)

• Initiated by: Credentialing Coordinator

• Initiated for: all facilities where the practitioner status is one in the active status group – most frequently active or provisional

• Completed: 6 months after the system reapplication date or when the facility status for all facilities has been changed to a status in the inactive status group

|Job and Task |Comment |

|Facility Notification | |

| Reapplication In Process |On process initiation, e-mail notification automatically sent to all |

| |facilities and task is automatically completed. |

|Reapplication | |

| All pages complete | |

| Peer References Specified | |

| Details 3 Month Gap |If no gap, delete task. |

| Declaration Question Explanation |If no yes answers, delete task. |

| Malpractice Explanation |If no yes answers, delete task. |

| Other Missing Information |If no information missing, delete task. |

|Documents | |

| Reapp Consent and Release | |

| Privilege Request Form |Use when submitted on paper. Delete task if submitted online. |

| CSOP Request Form |Use when submitted online. Delete task if submitted on paper. |

| |Document comment must read “Privilege Request CSOP” Document does not |

| |link to task. |

| Reapp Attestation |Task is deleted if not received and not PEC/PHO. |

| Supervising Physician Letter |Task is added to process for PA-C. |

| CBC Authorization |Task is added to the process if a CBC Report is needed. |

| CV | |

| CME Credits | |

| PPD Results | |

| Photograph | |

|Verify Licensure/Certification | |

| State License | |

| DEA License |Task is added to process if DEA License is to be verified. |

| DEA License Pending |Task is added to the process only if the practitioner has a DEA (not |

| |historical) and the PA DEA is pending. |

| Controlled Substance License |Task is added to process if Controlled Substance License is to be |

| |verified. |

| Certification |If not certified, the task is deleted. |

| Prescriptive Authority |Task is added to the process if Prescriptive Authority is to be |

| |verified |

|OIG Query | |

| OIG Query | |

|FSMB Query | |

| FSMB Query Request |Job is added only if requested. When FSMB Query request is sent, task|

| |is automatically completed. |

| FSMQ Query Report |Job is added to process only if requested. Task is completed when the|

| |FSMB Query results are available on the ID numbers user defined |

| |screen. |

|CBC Report | |

| CBC Request Sent |Delete task if CBC Report previously received. |

| CBC Report Received | |

|Verify Teaching Appointment | |

| Teaching Appointment Current | |

|Verify Malpractice Insurance | |

| Malpractice Insurance Current | |

|Verify Hospital Affiliations | |

| Hospital Affiliations Current | |

|Verify References | |

| Peer References | |

| Character References | |

|Verify Work History | |

| Work History Current | |

|Verify Military Service | |

| Military Service |Job/Task is added if Military Service to be verified. |

|Incomplete Reapplication Review | |

| Application Review |Enter date of next application review in the RVW date field. Task is |

| |not completed until verification is confirmed complete. |

|Validate Completed Items | |

| Run Validate Report |Task is completed after report is run and before verification is |

| |confirmed complete. |

|Verification Complete | |

| Confirm Verification Complete |Task is completed once verification has been confirmed complete. |

|Facility Notification | |

| Verification Complete |Once confirm verification complete, automatic e-mail is sent to all |

| |facilities and task is completed. |

|Process Complete | |

| Close Process |Once facility notification task is completed, task appears. The task |

| |is not completed until 6 months after verification is confirmed |

| |complete. The CVO director completes this task. |

|Discrepancy Letter | |

| Discrepancy Letter |Job/Task is added to process if discrepancy letter is needed. The task|

| |is not completed until the discrepancy is resolved. |

|Reapp Missing Item Letters | |

| Reapp Missing Items Letter |Job/Task is added to process if missing items letter is needed. Task |

| |is completed once verification has been confirmed. |

| Reapp Missing Items – Second Request |Job/Task is added to process if missing items letter is needed. Task |

| |is completed once verification has been confirmed. |

| Reapp Missing Items – Certified Letter |Job/Task is added to process if missing items letter is needed. Task |

| |is completed once verification has been confirmed. |

CVO PEC/PHO MD App CVOphoMD

• Initiated: to begin the verification process for a Managed Care initial credentialing application for a physician (MD, DO, DPM, DMD)

• Initiated by: Credentialing Coordinator

• Initiated for: the Managed Care facility (PEC) where the practitioner status is applicant

• Completed: once the facility status has been changed to active

|Job and Task |Comment |

| | |

|Facility Notification | |

| Application in Process |On process initiation, e-mail notification is automatically sent to |

| |facility and task is automatically completed. |

|PSD/PHO Application | |

| Declaration Questions |If no yes answers, delete task |

|Explained | |

| Malpractice Explanation |If no yes answers, delete task |

|Documents | |

| Attestation | |

| Malpractice Insurance Certificate |Note: the document does not attach to this task. |

|Verify Licensure/Certification | |

| State License | |

| State License Pending |Task is added when UPMC hospital affiliation verifications are not |

| |required and the PA state license has not been received. |

| DEA License | |

| DEA License Pending |Task is added to the process only if the practitioner has a DEA (not |

| |historical) and the PA DEA is pending. |

| Controlled Substance License |Task is added to process if Controlled Substance License is to be |

| |verified. |

| Board Certification |If not certified by a recognized board, delete the task. |

|OIG Query | |

| OIG Query | |

|Medicheck Query | |

| Medicheck Query | |

|EPLS Query | |

| EPLS Query | |

|FSMB Query | |

| FSMB Query Request |Job is added only if requested. When FSMB Query request is sent, task is|

| |automatically completed. |

| FSMB Query Report |Job is added to process only if requested. Task is completed when the |

| |FSMB Query results are available on the ID numbers user defined screen. |

|Verify Education |Job is added if practitioner is not certified by a recognized board. |

| Medical Education | |

| ECFMG Request |Task is added if practitioner has an ECFMG number. |

| ECFMG Report |Task is added if practitioner has an ECFMG number. |

| Internship | |

| Residency | |

| Fellowship | |

| AMA Profile |Task is added to process if AMA profile is obtained. |

| FCVS Report |Task is added to process if FCVS report is received. |

| Additional Education |Task is added to process when necessary. |

| Externship |Task is added to process when necessary. |

|Verify Hospital Affiliations | |

| Hospital Affiliations Current | |

|Incomplete Application Review | |

| Application Review |Enter date of next application review in the RVW date field. Task is not |

| |completed until verification is confirmed complete. |

|File on Hold | |

| File on Hold |Job/Task is added to the process if all tasks are complete except |

| |hospital affiliations that are pending |

|Validate Completed Items | |

| Run Validate Report |Task is completed after report is run and before verification is |

| |confirmed complete. |

|Verification Complete | |

| Confirm Verification Complete |Task is completed once verification has been confirmed complete. |

|Facility Notification | |

| Verification Complete |Once confirm verification complete, task is completed, automatic e-mail |

| |is sent to all facilities and task is completed. |

|File for QI Review | |

| File to Julie for QI Review |Once facility notification task is completed, task appears. The task is |

| |completed after file is given to the Credentialing Assistant responsible |

| |for review. |

|Process Complete | |

| Close Process |Once file for QI review task completed, task appears. The task is not |

| |completed until the facility status is changed to active. The CVO |

| |director completes this task. |

|Missing Items Letters | |

| Missing Items Letter |Job/Task is added to process if missing items letter is needed. Task is |

| |completed once verification has been confirmed. |

| Missing Items – Second Request |Job/Task is added to process if missing items letter is needed. Task is |

| |completed once verification has been confirmed. |

| Missing Items – Certified Letter |Job/Task is added to process if missing items letter is needed. Task is |

| |completed once verification has been confirmed. |

CVO PEC/PHO AHP App CVOphoAHP

• Initiated: to begin the verification process for a Managed Care initial credentialing application for an Allied Health Practitioner (all practitioners except MD, DO DPM, DMD)

• Initiated by: Credentialing Coordinator

• Initiated for: the Managed Care facility (PEC) where the practitioner status is applicant

• Completed: once the facility status has been changed to active

|Job and Task |Comment |

| | |

|Facility Notification | |

| Application in Process |On process initiation, e-mail notification automatically sent to |

| |facility and task is automatically completed. |

|PSD/PHO Application | |

| Declaration Questions |If no yes answers, delete task |

|Explained | |

| Malpractice Explanation |If no yes answers, delete task |

|Documents | |

| Attestation | |

| Malpractice Insurance Certificate |Note: the document does not attach to this task. |

|Verify Licensure/Certification | |

| State License | |

| State License Pending |Task is added when UPMC hospital affiliation verifications are not |

| |required and the PA state license has not been received. |

| DEA License |Task is added to process if DEA License is to be verified. |

| DEA License Pending |Task is added to the process only if the practitioner has a DEA (not |

| |historical) and the PA DEA is pending. |

| Controlled Substance License |Task is added to process if Controlled Substance License is to be |

| |verified. |

| Certification |If not certified, delete the task. |

|OIG Query | |

| OIG Query | |

|Medicheck Query | |

| Medicheck Query | |

|EPLS Query | |

| EPLS Query | |

|FSMB Query | |

| FSMB Query Request |Job is added only if requested. When FSMB Query request is sent, task |

| |is automatically completed. |

| FSMQ Query Report |Job is added to process only if requested. Task is completed when the |

| |FSMB Query results are available on the ID numbers user defined screen.|

|Verify Education | |

| Undergraduate Education | |

| Post Graduate Education | |

| Additional Training | |

| FCVS Report |Task is added to process if FCVS report is received. |

|Verify Hospital Affiliations | |

| Hospital Affiliation Current | |

|Incomplete Application Review | |

| Application Review | |

|File on Hold | |

| File on Hold |Job/Task is added to the process if all tasks are complete except |

| |hospital affiliations that are pending. |

|Validate Completed Items | |

| Run Validate Report |Task is completed after report is run and before verification is |

| |confirmed complete. |

|Verification Complete | |

| Confirm Verification Complete |Task is completed once verification has been confirmed complete. |

|Facility Notification | |

| Verification Complete |Once confirm verification complete, automatic e-mail is sent to all |

| |facilities and task is completed. |

|File for QI Review | |

| File to Julie for QI Review |Once facility notification task is completed, task appears. The task is|

| |completed after file is given to the Credentialing Assistant |

| |responsible for review. |

|Process Complete | |

| Close Process |Once file for QI review task is completed, task appears. The task is |

| |not completed until the facility status is changed to active. The CVO |

| |director completes this task. |

|Missing Item Letters | |

| Missing Item Letter |Job/Task is added to process if missing items letter is needed. Task |

| |is completed once verification has been confirmed. |

| Missing Items – Second Request |Job/Task is added to process if missing items letter is needed. Task |

| |is completed once verification has been confirmed. |

| Missing Items – Certified Letter |Job/Task is added to process if missing items letter is needed. Task |

| |is completed once verification has been confirmed. |

Mini Verification Processes

CVO State License CVOlicense

• Initiated: when verification is needed and there is no active Verification process

• Initiated by: a CVO staff member

• Initiated for: the CVO facility

• Completed: when the verification is received and available in the scanned images (provided that there is a document image – images of both the document and response are necessary for process completion)

|Job and Task |Comment |

| | |

|Verification State License | |

| State License | |

CVO DEA CVOdea

• Initiated: when verification is needed and there is no active Verification process

• Initiated by: a CVO staff member

• Initiated for: the CVO facility

• Completed: when the verification is received and available in the scanned images (provided that there is a document image – images of both the document and response are necessary for process completion)

|Job and Task |Comment |

| | |

|Verification DEA | |

| DEA License | |

CVO Board Certification CVOBoardMD

• Initiated: when verification is needed and there is no active Verification process

• Initiated by: a CVO staff member

• Initiated for: the CVO facility

• Completed: when the verification is received and available in the scanned images (provided that there is a document image – images of both the document and response are necessary for process completion)

|Job and Task |Comment |

| | |

|Verification Board Certification | |

| Board Certification | |

CVO Certification CVOCertAHP

• Initiated: when verification is needed and there is no active Verification process

• Initiated by: a CVO staff member

• Initiated for: the CVO facility

• Completed: when the verification is received and available in the scanned images (provided that there is a document image – images of both the document and response are necessary for process completion)

|Job and Task |Comment |

| | |

|Verification Certification | |

| Certification | |

CVO FSMB CVOfsmbact

• Initiated: when verification is needed and there is no active Verification process

• Initiated by: a CVO staff member

• Initiated for: the CVO facility

• Completed: when the Query report is requested

|Job and Task |Comment |

| | |

|FSMB Query | |

| FSMB Query Request | |

CVO Medicheck Query CVOmedck

• Initiated: when verification is needed and there is no active Verification process

• Initiated by: a CVO staff member

• Initiated for: the CVO facility

• Completed: when the verification is received and available in the scanned images

|Job and Task |Comment |

| | |

|Medicheck Query | |

| Medicheck Query Request | |

CVO OIG Query CVOoig

• Initiated: when verification is needed and there is no active Verification process

• Initiated by: a CVO staff member

• Initiated for: the CVO facility

• Completed: when the verification is received and available in the scanned images

|Job and Task |Comment |

| | |

|OIG Query | |

| OIG Query Request | |

CVO Hospital Affiliations MD Current CVOchospMD

• Initiated: when verification is needed and there is no active Verification process

• Initiated by: a CVO staff member

• Initiated for: the CVO facility

• Completed: when the verification is received and available in the scanned images

|Job and Task |Comment |

| | |

|Verify Hospital Affiliations | |

| Hospital Affiliations Current | |

CVO EPLS Query CVOepls

• Initiated: when verification is needed and there is no active Verification process

• Initiated by: a CVO staff member

• Initiated for: the CVO facility

• Completed: when the verification is received and available in the scanned images

|Job and Task |Comment |

| | |

|EPLS Query | |

| EPLS Query Request | |

Reverification Processes

CVO Residency CVOresid

• Initiated: when the verification of completion of the Residency is needed and the Residency verification was received previously

• Initiated by: the CVO Director for the June 30 reverifications and monthly by the Lead Credentialing Coordinator for programs completed during the prior month

• Initiated for: all facilities where the practitioner status is one in the Applicant or Active status group

• Completed: when verification(s) have been received and are available in the scanned images

|Job and Task |Comment |

| | |

|Reverify Residency | |

| Residency Reverification | |

| Program Director Evaluation |If the Program Director Evaluation is not included with the |

| |verification of completion and was not completed previously, the |

| |Program Director data is entered on the reference screen and the task |

| |is added to the process. |

| Confirm Verification Complete | |

CVO Fellowship CVOfellow

• Initiated: when the verification of completion of the Fellowship is needed and the Fellowship verification was received previously

• Initiated by: the CVO Director for the June 30 reverifications and monthly by the Lead Credentialing Coordinator for programs completed during the prior month

• Initiated for: all facilities where the practitioner status is one in the Applicant or Active status group

• Completed: when verification(s) have been received and are available in the scanned images

|Job and Task |Comment |

| | |

|Reverify Fellowship | |

| Fellowship Reverification | |

| Program Director Evaluation |If the Program Director Evaluation is not included with the |

| |verification of completion and was not completed previously, the |

| |Program Director data is entered on the reference screen and the task |

| |is added to the process. |

| Confirm Verification Complete | |

CVO Internship CVOintern

• Initiated: when the verification of completion of the Internship is needed and the Internship verification was received previously

• Initiated by: the Credentialing Coordinator when an individual reverification is needed

• Initiated for: all facilities where the practitioner status is one in the Applicant or Active status group

• Completed: when verification(s) have been received and are available in the scanned images

|Job and Task |Comment |

| | |

|Reverify Internship | |

| Internship Reverification | |

| Confirm Verification Complete | |

CVO Post Graduate CVOpostgra

• Initiated: when the verification of completion of the Post Graduate Education is needed and the Post Graduate Education verification was received previously

• Initiated by: the CVO Director for the June 30 reverifications and monthly by the Lead Credentialing Coordinator for programs completed during the prior month

• Initiated for: all facilities where the practitioner status is one in the Applicant or Active status group

• Completed: when verification(s) have been received and are available in the scanned images

|Job and Task |Comment |

| | |

|Reverify Post Graduate | |

| Post Graduate Reverification | |

| Confirm Verification Complete | |

CVO Research Fellowship CVOfellow

• Initiated: when the verification of completion of the Research Fellowship is needed and the Research Fellowship verification was received previously

• Initiated by: the CVO Director for the June 30 reverifications and monthly by the Lead Credentialing Coordinator for programs completed during the prior month

• Initiated for: all facilities where the practitioner status is one in the Applicant or Active status group

• Completed: when verification(s) have been received and are available in the scanned images

|Job and Task |Comment |

| | |

|Reverify Research Fellowship | |

| Research Fellowship Reverification | |

| Program Director Evaluation |If the Program Director Evaluation is not included with the |

| |verification of completion and was not completed previously, the |

| |Program Director data is entered on the reference screen and the task |

| |is added to the process. |

| Confirm Verification Complete | |

Expirables Processes

CVO Expirables CVOexpirab

• Initiated: when verification is needed and there is no active Verification process

• Initiated by: Director

• Initiated for: the CVO facility

• Completed: when the verification is received and available in the scanned images (provided that there is a document image – images of both the document and response are necessary for process completion)

|Job and Task |Comment |

| | |

|Expired Document Verification | |

| State License | |

| DEA | |

| Board Certification | |

| Certification (AHP) | |

| Prescriptive Authority | |

CVO Expirables AHP Cert CVOexAHPce

• Initiated: when verification is needed and there is no active Verification process

• Initiated by: Director

• Initiated for: the CVO facility

• Completed: when the verification is received and available in the scanned images (provided that there is a document image – images of both the document and response are necessary for process completion)

|Job and Task |Comment |

| | |

|Expired Document Verification | |

| Specialties Certified | |

CVO Expirables MD Spec CVOexMDspe

• Initiated: when verification is needed and there is no active Verification process

• Initiated by: Director

• Initiated for: the CVO facility

• Completed: when the verification is received and available in the scanned images (provided that there is a document image – images of both the document and response are necessary for process completion)

|Job and Task |Comment |

| | |

|Expired Document Verification | |

| Specialties Board | |

Quality Improvement Processes

CVO QI Review CVOQIrev

• Initiated: process is auto-launched when the PEC/PHO application is received

• Initiated for: the CVO facility

• Completed: when the QI file review is complete

|Job and Task |Comment |

| | |

|File Review | |

| File Review Complete | |

|Facility Notification | |

| Notify Facility | |

CVO Notify Practitioner CVOnotify

• Initiated: when an email needs to be sent to a list of practitioners

• Initiated by: Director

• Initiated for: the CVO facility

• Completed: when the email has been sent

|Job and Task |Comment |

| | |

|Notify Practitioner | |

| Notify Practitioner | |

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