Which organization defines credentialing as the process of reviewing and evaluating qualifications of licensed independent practitioners to provide services to its members?

Which organization defines credentialing as the process of reviewing and evaluating qualifications of licensed independent practitioners to provide services to its members?

• A. AAAHC Definition of Credentialing
• B. NCQA Definition of Credentialing
• C. TJC Definition of Credentialing
• D. Policy and Procedures

Answer: (B)

The organization described is NCQA. NCQA defines credentialing as the process of reviewing and evaluating the qualifications of licensed independent practitioners to provide services to its members. This aligns with how health plans and managed care organizations ensure that providers in their networks meet required standards before they can serve members. It emphasizes a focus on validating credentials so practitioners are qualified to care for plan members. In contrast, accrediting bodies like AAAHC or The Joint Commission center their definitions on accrediting organizations and facilities, and policy and procedures are internal guidelines rather than an external definition from a governing body.

The organization described is NCQA. NCQA defines credentialing as the process of reviewing and evaluating the qualifications of licensed independent practitioners to provide services to its members. This aligns with how health plans and managed care organizations ensure that providers in their networks meet required standards before they can serve members. It emphasizes a focus on validating credentials so practitioners are qualified to care for plan members. In contrast, accrediting bodies like AAAHC or The Joint Commission center their definitions on accrediting organizations and facilities, and policy and procedures are internal guidelines rather than an external definition from a governing body.