The Application Process (#1)

Question 1

Pre-Application Form

Answer 1

Screens applicants for membership eligibility

Question 2

Review of Application

Answer 2

• Application= education, training, experience, contact information, dates for PSV, no time gaps
• An application is considered complete when all required information is provided; must be signed & dated

Question 3

Gaps

Answer 3

Gaps= Medical school- time of application

- All gaps should be explained by the applicant

Question 4

Practitioner Questions

Answer 4

Any “Yes” requires explanation

Question 5

TJC on Practitioner Questions

Answer 5

Require statement of no health issues
Investigate:
- Challenges/ relinquishment of licensure
- Termination of medical staff membership
- Limitation, reduction or loss of clinical privileges
- Excessive number of PL actions resulting in final judgment against applicant

Question 6

HFAP on Practitioner Questions

Answer 6

Application requests following information:

• Disciplinary actions/ investigations by hospitals, boards, Medicare/ Medicaid
• Actions against DEA or CDS
• Actions listed on NPDB
• Information regarding criminal history

Question 7

DNV on Practitioner Questions

Answer 7

No specific requirements

Question 8

NCQA on Practitioner Questions

Answer 8

Current & signed attestation required

• Reasons for any inability to perform essential functions of the position
• Illegal drug use
• Loss of license/ felony convictions
• Loss/ limitation of privileges or disciplinary activity
• Current PL coverage
• Correctness & completeness of application

Question 9

URAC on Practitioner Questions

Answer 9

Application includes:

• History of sanctions
• Loss/ limitation of privileges or disciplinary activity
• Disclosure of any physical, mental or substance abuse problems that could impede practitioner’s ability to provide care

Question 10

AAAHC on Practitioner Questions

Answer 10

Organization requires information on:

• Complaints or adverse actions by professional society, licensing board
• Licensure disciplinary actions
• Refusal of PL
• Criminal convictions
• Medicare/ Medicaid sanctions
• Current physical/ mental health
• Chemical dependency problems

Question 11

Red Flags

Answer 11

No reference to quality of care of FV need to be investigated
Red flags should be investigated fully
- Missing dates/ gaps in training/ professional practice
- Discrepancies between information provided & information verified
- Interruption of training
- Hospital privileges listed as “Active” but verified as “Consulting” or “Courtesy”
- Active privileges that become “Courtesy” or “Inactive” without explanation
- Challenges to license/ DEA
- Excessive PL history
- PL canceled for any reason
- Ambiguous peer references
- References/ PSVs that only refer to dates not disciplinary actions