Which accreditation does not require credentialing in these settings: inpatient setting for organizational members only, pharmacy benefits management, or locum tenens unless over 90 days?

Which accreditation does not require credentialing in these settings: inpatient setting for organizational members only, pharmacy benefits management, or locum tenens unless over 90 days?

• A. URAC
• B. TJC
• C. CMS
• D. NCQA

Answer: (D)

Credentialing expectations vary by accrediting body, especially for temporary staffing and internal staffing arrangements. NCQA’s approach centers on network quality and allows temporary staffing arrangements without full credentialing verification for a limited period, typically up to 90 days for locum tenens. When inpatient care is provided within the organization by its own members or in pharmacy benefits management operations, NCQA relies on the organization’s governance and internal credentialing processes rather than requiring separate, external credentialing for every individual practitioner in those settings. In contrast, The Joint Commission and URAC standards emphasize formal credentialing and privileging for medical staff and personnel involved in patient care across these settings, and CMS conditions of participation require provider credentialing as part of participating facilities. Those bodies therefore have more stringent credentialing requirements for these scenarios. Thus, NCQA is the accreditation that does not necessitate credentialing in these particular contexts.

Credentialing expectations vary by accrediting body, especially for temporary staffing and internal staffing arrangements. NCQA’s approach centers on network quality and allows temporary staffing arrangements without full credentialing verification for a limited period, typically up to 90 days for locum tenens. When inpatient care is provided within the organization by its own members or in pharmacy benefits management operations, NCQA relies on the organization’s governance and internal credentialing processes rather than requiring separate, external credentialing for every individual practitioner in those settings. In contrast, The Joint Commission and URAC standards emphasize formal credentialing and privileging for medical staff and personnel involved in patient care across these settings, and CMS conditions of participation require provider credentialing as part of participating facilities. Those bodies therefore have more stringent credentialing requirements for these scenarios. Thus, NCQA is the accreditation that does not necessitate credentialing in these particular contexts.