Which accreditation defines credentialing as the process by which an organization reviews and evaluates the qualifications of licensed independent practitioners to provide services to its members?

Which accreditation defines credentialing as the process by which an organization reviews and evaluates the qualifications of licensed independent practitioners to provide services to its members?

• A. URAC
• B. TJC
• C. NCQA
• D. AAAHC

Answer: (C)

Credentialing is the process of verifying a licensed independent practitioner’s qualifications before they provide care to a client group. In the NCQA framework, this definition is rooted in ensuring that providers who join a health plan’s network are qualified to deliver services to the plan’s members. Practically, this means checking and validating licensure, education, board certification where relevant, sanctions or disciplinary history, malpractice claims, and practice history, then approving or denying participation based on these verifications. This verification is done before a practitioner can serve members and is repeated at intervals to confirm ongoing eligibility through re-credentialing. The emphasis on serving plan members and maintaining a qualified network is what makes NCQA the best fit here. Other accreditors also address credentialing, but their standard language and focus differ (for example, hospital or ambulatory care settings and broader care quality contexts), whereas NCQA centers credentialing around ensuring providers are able to deliver care to health plan members.

Credentialing is the process of verifying a licensed independent practitioner’s qualifications before they provide care to a client group. In the NCQA framework, this definition is rooted in ensuring that providers who join a health plan’s network are qualified to deliver services to the plan’s members. Practically, this means checking and validating licensure, education, board certification where relevant, sanctions or disciplinary history, malpractice claims, and practice history, then approving or denying participation based on these verifications. This verification is done before a practitioner can serve members and is repeated at intervals to confirm ongoing eligibility through re-credentialing. The emphasis on serving plan members and maintaining a qualified network is what makes NCQA the best fit here. Other accreditors also address credentialing, but their standard language and focus differ (for example, hospital or ambulatory care settings and broader care quality contexts), whereas NCQA centers credentialing around ensuring providers are able to deliver care to health plan members.