Credentials requirements

Credentialing requirement

Contractor agrees to credential each practitioner providing health services in a program covered by the terms of this contract. Credentialing must be performed through a process that meets credentialing standards of the National Committee for Quality Assurance (NCQA).

Contractors shall ensure that all Contractor-employed providers of direct patient services be qualified, and have privileges granted, to perform those services for which they are employed, or for which they have volunteered. Contractors will ensure that such providers are:

• Licensed, certified, or registered as verified through a credentialing process, in accordance with applicable Federal, state, and local laws; and
• Competent and fit to perform the contracted scope of work and/or assigned duties, as assessed through a privileging process.

For the purposes of contracts with PHSKC, privileging does not refer to providers' hospital admitting privileges. Rather privileging in this context refers to a process "of authorizing a health care practitioner's specific scope and content of patient care services," verifying that the practitioner's clinical competence, and/or verifying fitness for duty, as outlined in the HRSA Health Center Program Compliance Manual.

Health plan enrollment

In addition to the credentialing requirement, all contracted practitioners who practice at PHSKC clinics and sites and who perform or sign off on PHSKC billable patient encounters will be enrolled in PHSKC's paying health plans.

Plan enrollment entails credentialing by the plans. Enrollment is accomplished in part through retrieval of provider information that resides in OneHealthPort/ ProviderSource, the state-mandated portal and repository for state-wide health provider credentialing data. Therefore, health practitioners being enrolled in health plans need to have their credentialing information in OneHealthPort/ProviderSource.

Public Health will manage data entry of the Contracted practitioners' data into ProviderSource. The following actions must be completed:

• Practitioner requests a copy of their current Washington Practitioner Application (WPA) from their credentialing office using their organization's authorization process.
• Practitioner sends a copy of their WPA and any recent updated attestations, and a clear copy of their driver's license or other government issued picture identification, updated copies of liability face sheets, practitioner licenses and certifications to Public Health- Seattle & King County Credentials section by US mail or fax. Do not send this information by e-mail unless you are able to send in a secure manner.
• PHSKC Credentialing staff will nominate each practitioner in OneHealthPort and communicate to each practitioner their user ID and activation code, which are needed to create their account in OneHealthPort/ProviderSource. Practitioner will use this information to create an initial account in OneHealthPort which will allow input of their data to ProviderSource by Medversant or PHSKC.
• After data entry, the practitioner will be notified to log into their OneHealthPort/ProviderSource record to review the information for accuracy, answer disclosure questions and indicate the payer plans that will be allowed access to the record (as advised by PHSKC) and electronically attest to their WPA.

Electronic re-attestation is required every 150 days by ProviderSource, and practitioners will receive a renewal notice close to that time. A provider will not have billable visits at PHSKC until they are enrolled in plans, so it is critical that the process described here is completed quickly.