Solutions: Credentialing

Provider Credentialing Verification Services are available through HealthNet Data Link, Inc. (HDL), an eHDL company.

HDL offers a complete line of Credentialing Verification Services including: Initial Credentialing, Continuous Credentialing, Re-appointment/Re-credentialing, Pre-population of Applications, Mail-out, and “Rush” Services.

Secure authorized access is available On-Line to Provider credentials, reports, summary and “Tickler” information, data tracking, and updating.

Provider Credentialing Verification Services are available for Hospitals, based upon JCAHO Hospital standards, and Managed Care Organizations, based upon NCQA Managed Care Standards. HDL is fully certified by NCQA* for 9 out of 9 verification services.

HDL-hospital customers have scored between 94-100% on JCAHO surveys.

Experience The Difference!

• Timely completion of records
• Current data on provider
• Secure on-line access
• Custom reporting
• "Tickler" system updates

• Credentialing Departments
• HMO’s, PPO’s, PHO’s, MSO’s, and IPA’s
• Home Health Agencies
• Hospitals and Hospital Systems
• Managed Care Organizations
• Medical Staff Offices
• MIS Directors
• MSOs
• Outpatient Surgery Centers
• Payer Sponsored Networks
• Provider Sponsored Networks
• Provider Relations Managers
• Physician Networks
• Clinics

Initial Credentialing
The HDL Initial Credentialing Verification Program includes primary source verification of the following:

• License to Practice
• Hospital Privileges
• DEA/CDS Registration
• Education/Residency/Board Certification
• Internship & Fellowship
• Malpractice Insurance
• Malpractice Claims History
• Application Processing
• NPDB Query
• Sanctions Against Licensure
• Medicaid/Medicare Sanctions

The complete package for Initial Credentialing Verification Services include a 2-page computer generated summary report (checklist), and portfolio containing primary source verified hard copies. Status reports are also available.

HDL credentials all Providers and Allied Health Workers in the health care industry.

Credentialing Standards meet NCQA, JCAHO, and Facility Policies & Procedures.

Re-Appointment/Re-Credentialing
The HDL Re-Appointment/Re-Credentialing Verification Services Program includes full primary source verification every two years (JCAHO) or three years (NCQA) for the following documents:

• License To Practice
• Hospital Privileges
• DEA/CDS Registration
• Board Certification
• Malpractice Insurance
• Malpractice Claims History
• Application Processing
• NPDB Query
• Sanctions Against Licensure
• Medicaid/Medicare Sanctions

Pre-Populated Application Services
Using HDL’s standard application form (with Provider and customer approval) can be pre-populated to reduce errors and Provider’s time in filling out these applications. Many organizations provide HDL an Initial, Re-appointment, or Re-credential application in hard copy or electronic formats, such as Microsoft Word, Microsoft Excel, or ASCII text file with the following information:

• Provider Name
• Address
• City, State, Zip
• Phone & Fax
• E-Mail
• State License and Expiration Date
• DEA License and Expiration Date
• Controlled Dangerous Substance and Expiration Date
• Malpractice Insurance and Expiration Date
• Medical School and Graduation Date
• Date of Birth
• Specialty of Practice
• Current Privileges Status

Continuous Credentialing Services
The HDL Continuous Credentialing Program features monthly updates of time-sensitive documents, such as:

• State License to Practice
• DEA/CDS Registration
• Malpractice Insurance

All updated documents will either be mailed, or faxed to your secure fax number on a weekly basis.

Status Reports and Updates
Detailed Status Reports can be downloaded by or faxed to authorized users through secure username and password access. Upon review of Status Reports, customers can prioritize the workload for upcoming Peer Review Committee meetings. HDL in fact, becomes your right arm in a pressure-packed, yet always exciting credentialing verification environment.

“RUSH” Services
The average turnaround time for processing a file is between 40-60 days. HDL’s “Rush” Services will fully credential your Provider files in 30 days or less.

AMA Physician Profile
AMA Physician Profiles are used for primary source verification, whenever the physician has completed his or her medical school training out side of the United States. AMA Profiles are also used whenever a primary source charges $25 or more dollars for a document. AMA Profiles, in cases such as the above, will give the customer much more value for almost the same price.

Pre-Populated Re-Appointment Applications
HDL Pre-Populated Re-Appointment applications are available, so long as the customer submits to HDL their files in Microsoft Word, Microsoft Excel, or ASCII text file formats with the following information:

• Provider Name
• Address
• City, State, Zip
• Phone & Fax
• E-Mail
• State License and Expiration Date
• DEA License and Expiration Date
• Controlled Dangerous Substance and Expiration Date
• Malpractice Insurance and Expiration Date
• Medical School and Graduation Date
• Date of Birth
• Specialty of Practice
• Current Privileges Status

Call today at 800-338-1079, X1512, if we can be of professional service to your Health Care Organization…

*”The National Committee of Quality Assurance is an independent, non-profit organization that certifies credentials verification organizations, and accredits managed care organizations.”