Learning
Credentialing
Compliance
If it’s not documented, it didn’t happen.
That’s a pretty standard sentiment among healthcare surveyors. It’s what makes tracking and reporting a critical part of compliance and accreditation. The National Committee for Quality Assurance (NCQA) credentialing standards set the bar for the industry, so it’s no surprise that a certified or accredited organization will need comprehensive reporting capabilities.
Luckily, MedTrainer’s credentialing platform puts all your data in one location with highly-customizable reports to simplify compliance with NCQA credentialing standards. Let’s take a closer look at the standards and how MedTrainer simplifies your adherence.
Policies and Procedures
NCQA credentialing standards require that all healthcare organizations have a “well-defined credentialing and recredentialing process for evaluating and selecting licensed independent practitioners to provide care to its members.”
Documented policies and procedures should include information such as: types of practitioners credentialed, verification sources used, criteria for credentialing, process for making credentialing decisions, process for managing credentialing files, process for ensuring confidentiality and non-discrimination, and more.
MedTrainer Document & Policy Management makes it easy to create, organize, store, and track policies and procedures. Consider using the drag-and-drop foldering system to put all NCQA credentialing-related policies together for easy access during a survey. Version history, board approvals, and staff acknowledgement are automatically tracked and can be pulled into reports that you can save, export, and schedule to be emailed. You can easily track and report on stored documents and important dates, such as last revision and expiration dates.
Credentialing Requirements
This specifies what needs to be included in the submission of a credentialing application (a minimum of six factors), as well as primary source verification (PSV) of: provider’s license, DEA permit or CDS certificate, education, board certification, work history, malpractice, and sanctions.
Securing and storing all of these PSV documents in the MedTrainer platform makes reporting options nearly limitless. Any data in the system can be pulled into a customizable report. NCQA changes for 2025 require the tracking of provider language, race and ethnicity (if provided). These fields are already part of MedTrainer’s provider profile and can be added to any reports.
MedTrainer automates license verification for all states, all license types, and DEA registrant validation. The primary source document is pulled into the platform and when you verify it, your name, the date, and trusted URL are tracked for easy reporting. You can add document expiration dates to meet the updated credentialing standard that requires tracking of license expiration dates.
Webinar: Setting a New Standard for PSV
Recredentialing Verification and Cycle Length
The recredentialing standards ensure organizations have appropriate processes in place to complete timely and accurate recredentialing every three years.
Since every provider is on a different recredentialing schedule, seeing a report every month will help you to stay on top of what is needed. MedTrainer Reports will take care of that for you, once all the related dates are in the system (submission, credentialing approval, contract effective date, recredentialing, etc.). You can customize and schedule the report to be emailed monthly to stay ahead of the next deadline.
The easiest way to see the status of all recredentialing documents at-a-glance is through the credentialing packet template. With your templates customized by provider location and specialty, the required documents are updated in real-time so you always know where you stand. You can download one PDF with all your documents to further simplify your workflow.
Ongoing Monitoring
Ongoing monitoring has always been critical in quickly surfacing potential risks, but now it is becoming a standard part of the credentialing process since technology simplifies the time and effort involved.
MedTrainer offers automated exclusions monitoring for 40+ state and federal databases, including the OIG (Office of Inspector General) LEIE (List of Excluded Individuals and Entities) and SAM (System Award Management). These exclusions are run on a NCQA-compliant schedule and a notification is sent when a provider’s status changes. The automated exclusion process, and the accompanying reports, meet the 2025 NCQA credentialing standard updates that require checks to be completed every 30 days for OIG and SAM.
All exclusions data can be pulled into a report that you can save for easy access. Filter and sort as needed to see important fields such as the date of the last check, the status of sanctions, and more. You can also layer additional information, such as CAQH last attestation date and National Practitioner Data Bank (NPDB) information for a comprehensive assessment of your organization’s risk and compliance.
Ready to learn more about MedTrainer’s credentialing platform and comprehensive reporting capabilities? Get in touch!
