Preparing for an Electronic Credentialing Approval Process

Preparing for an Electronic Credentialing Approval Process

Sep 12, 2017
  • Author:
    Katy Young, MBA, CPCS
    Senior Manager, Customer Support
    Katy Young began her journey in the world of Provider Credentialing with Texas Children's Hospital as their System Administrator for the Echo Credentialing platform. She came on with VerityStream as a trainer and then moved over to the Consulting Team shortly after. During her time on the Consulting Team, she wrote Articles, presented Webinars and at Conferences, and assisted numerous clients through their implementation of CredentialStream. Katy brings her understanding of the Credentialing Industry to every interaction with our clients.

The electronic credentials review process, where the thick packet of all applicant information goes away, is a goal for many Medical Staff Offices. Dreaming of the days when the cart isn’t being used for file movement and appointments aren’t made to come into the MSO to complete the review is attainable. If you are looking to that day as a goal for the next quarter or year, there are components that can be taken early to lay the foundation for success.

Taking the time to prepare your internal stakeholders and bring critical departments into the process can solidify the goal and unite the organization in regards to the initiative.

Policies and Procedures

Ensuring your organization’s policy and procedure documents are up to date and reflective of current processes, as well as industry regulations, is the foundation for preparing to go electronic.

Legal Department
The legal department or your organization’s legal representative should be brought into the discussion while making changes to policies, bylaws, or rule books for your organization. These individuals will be able to ensure compliance with local, state, and federal laws concerning the review process and standards.

Accreditation Committee or Representative
Compliance with accreditation agency standards and expectations will best be supported when your organization’s Accreditation Committee or a representative from the committee has an opportunity to work with your team to update policies. This individual or committee will have the ability to outline requirements and ensure that any changes to the process due to a move to an electronic review process are within accreditation standards. In addition, working closely with accreditation teams during the transition may also ensure that a comprehensive plan is in place for meeting all requirements of an audit before, during, and after the electronic review process has been implemented. As with including the legal department in this transition, transparency and inclusion regarding this initiative will support unification surrounding the goal.

Board of Trustees
Each organization has slightly differing rules surrounding updates to Medical Staff Policies and Rules and Regulations. The success of this initiative will be supported when this group is brought in early in the process.


Transitioning to an electronic review process from a paper based review process is a big change. Though for many, a welcome change, it does require making decisions on what information will be presented to the reviewers in a standardized format that meets the requirements and needs for all. With an electronic review packet, each reviewer cannot decide what they want to see in a packet. The process of changing the packet and obtaining support for a standardized review packet will go smoother with physician champions and leaders involved in the design and decisions.

Get Support for the Change
A Physician Champion or advocate who is technically savvy and well respected in the organization will help to garner support with the many touch points and individuals who are involved in the process. As with many changes in healthcare, those affected by the change will feel more comfortable when a trusted member of the medical staff is acting as the Champion of this change. The earlier that a Physician Leader can be identified and brought into the process, the better. An open line of communication concerning the information that will be included will help to ensure that physician reviewers don’t feel that they have lost the control of what they have access to when making decisions concerning who to bring on staff and what privileges they will be granted.

Review Packet
The packet represents the information that will be presented to the individual reviewers and subsequent committees during the electronic applicant review process. The packet will replace the paper files that have been used up until this initiative has begun. In the paper review process, most organizations provide the full packet of information including the application, CV, all verification letters sent, all verification letters received and all supporting documentation. The purpose of transitioning to an electronic process is to streamline the process as a whole. This includes reviewing and revising the packet to provide meaningful and critical information the decision makers need to make appropriate and accurate recommendations

This information should be organized in such a manner where the reviewer can easily identify critical components including any red flags, quickly review the applicant profile and streamline their review process – enabling them to make an accurate and thoughtful recommendation. The decisions regarding what will be included and what can be removed from this packet requires review and agreement with individuals outside of the Medical Staff Office.

What’s in a packet
The department leaders, facilities and accreditation teams have varying requirements in what must be reviewed by the reviewers and subsequent committees. By ensuring these individuals or groups are involved in the decision points regarding the contents of the packet will ensure that your organization is prepared for the transition.

Required Items
Identify the items that will be included in the packet. Review your accreditation standards with your accreditation representative, legal department, and Physician Leadership team(s).

The packet of information typically includes a profile of the applicant’s demographics and history including:

  1. Personal Information such as name, address, NPI
  2. Education information such as Medical School, Graduate Education
  3. Training such as internships, residencies, and fellowships
  4. Affiliations such as current and prior hospital affiliations
  5. Work History such as clinical practices, gaps in history
  6. Malpractice Carriers including claims history
  7. References including Peer, Program Directors, Department Chairs
  8. Licenses and Certifications including current state licenses, DEA, Board Certifications
  9. Requested Privileges including privileges requested, case logs, training criteria
  10. Queries to Federal, State, and Local Agencies: NPDB,EPLS and SAM,Other Federal Sites and Sanctions Monitoring
  11. Primary source verification for any red flags
  12. Primary source verifications of references

Identify those items that must be included in the packet for review, should comply with policies and procedures for the organization, accreditation agency criteria, as well as requirements from reviewers based on what they need to make an informed decision concerning the applicant to the Medical Staff.

It is also important to note that there may be differences in the required items for review based on Initial or Reappointment Applications as well as Allied Health Providers or MDs and APPs.

The format for the electronic packet should be developed with the Physician Champion and Leadership. Ease in identification of red flags, format of the profile of applicant and additional information should be easy to follow and usable.

Develop a sample electronic review layout to be used can be helpful to identify those records that can be presented in text format, pulled directly from your software vs. those items that must also include a scanned image. Regardless of the software being used to complete this review, the packet of information needs to be laid out in a usable format or the reviewers will not adapt to new processes.

Legal Department
The legal department or representative should be involved in any changes to what reviewers see regarding the applicants to the Medical Staff to support a smooth transition to electronic files. With the many differences between required items to be reviewed and the laws protecting both organizations as well as applicants, it will be in the best interest of the organization to obtain sign off from the legal department concerning what is included in the packet.

Build the Packet and Review

Your organization can now put it all together and build out the packet itself for pilot testing and, finally, roll out. The time invested in taking the time early to work with internal teams on the packet requirements will help to set your organization up for a successful and easier roll out of the full electronic review process.