Glossary of Terms

CAH (Critical Access Hospital) – Most critical access facilities are CMS licensed.

CAQH (Council for Affordable Quality Healthcare) – is a not-for-profit collaborative alliance of the nation’s leading health plans and networks. It has become the universal credentialing data source for insurance enrollment.

Clinical Competency – The ability to perform procedures in a proficient and competent manner.

Clinical Privileges – Those procedures or processes a practitioner wants the ability to perform at a clinical facility.

CMS – Centers for Medicare and Medicaid Services.

Continuous Query – An automatic notification of any report submitted to the National Practitioner Data Bank on behalf of any practitioner enrolled.

CVO (Centralized Verification Organization) – A centralized verification organization verifies provider information, such as medical school training and previous practice sites, on behalf of participating clients. This single verification system reduces costs and minimizes errors for credentialing queries while eliminating duplication of requests required of providers

CVS (Centralized Verification Service) – (see CVO)

Initial Appointment – The process of making initial application to a medical staff or membership and/or clinical privileges

Joint Commission – An independent not-for-profit organization, The Joint Commission accredits and certifies more than 19,000 health care organizations and programs in the United States. Joint Commission accreditation and certification is recognized nationwide as a symbol of quality that reflects an organization’s commitment to meeting certain performance standards

NPDB (National Practitioner Data Bank) – The Data Bank, consisting of the National Practitioner Data Bank (NPDB) and the Healthcare Integrity and Protection Data Bank (HIPDB), is a confidential information clearinghouse created by Congress to improve health care quality, protect the public, and reduce health care fraud and abuse in the U.S.

NPI (National Provider Identifier) – is an identification number assigned to each health care provider by CMS. It is a 10-digit number used for a variety of reasons in the health industry.

PECOS (Provider Enrollment Chain and Organization System) – is a system used by Medicare for physician/non-physician practitioners and organizations that have been approved. This system is used to store and update provider/supplier information.

Physician Onboarding – A series of sequential processes required to bring a prospective new member of the clinical staff to a
fully-functioning and billable state. For most organizations, this involves recruitment, employment, credentialing, privileging, appointment and payor enrollment.

MPR does not currently perform provider recruitment, nor do we assist in the employment process, but we are able to help with credentialing, privileging and payor enrollment (fondly referred to as provider enrollment).

Practitioner – Any applicant to the medical or allied health staff of a facility.

Primary Source Verification – The process of obtaining verification directly from the primary source (i.e. school of medicine, training program, hospital, etc.) rather than relying on information shared by a secondary source.

Reappointment – The routine re-evaluation of any practitioner for membership or clinical privileges in a medical facility.

Taxonomy codes – are 10-character, federally established alphanumeric codes that health care professionals use to identify their unique specialty areas.  They are a combination of Provider Type and Provider Specialty and self-declared by health care providers during the National Provider Identified (NPI) enumeration process. The Health Care Provider Taxonomy code set is developed by CMS and published twice a year in July and January.

Turn-Around-Time (TAT) – The calculation for processing a practitioner’s credentialing file, beginning with the date Medical Provider Resources starts processing to the time the file is deemed complete.