To whom must all credentials be submitted for a decision under NCQA?

To whom must all credentials be submitted for a decision under NCQA?

• A. Medical Director
• B. Credentialing Committee or Medical Director
• C. Governing Body
• D. Hospital Administration

Answer: (B)

In NCQA credentialing, the decision on an applicant’s qualifications is made by the organization’s credentialing authority—the Credentialing Committee—often with the Medical Director in the decision-making role when there isn’t a separate committee. This structure ensures that verified information about licensure, privileges, certifications, and practitioner history is reviewed by qualified peers or leaders before any privileging decisions are rendered. The Governing Body typically reviews and approves the committee’s recommendations rather than handling the credentialing decision itself, and hospital administration handles operations rather than the substantive credentialing judgment. So the credentialing file is submitted to the Credentialing Committee or the Medical Director for the decision, reflecting a formal review process by the appropriate credentialing authority.

In NCQA credentialing, the decision on an applicant’s qualifications is made by the organization’s credentialing authority—the Credentialing Committee—often with the Medical Director in the decision-making role when there isn’t a separate committee. This structure ensures that verified information about licensure, privileges, certifications, and practitioner history is reviewed by qualified peers or leaders before any privileging decisions are rendered. The Governing Body typically reviews and approves the committee’s recommendations rather than handling the credentialing decision itself, and hospital administration handles operations rather than the substantive credentialing judgment.

So the credentialing file is submitted to the Credentialing Committee or the Medical Director for the decision, reflecting a formal review process by the appropriate credentialing authority.