At MPR, we believe the credentialing and enrollment process is the first step in patient care. We take that responsibility seriously and we are here to meet your needs and help you serve your patients and your team. Please check out our Frequently Asked Questions below or feel free to call us anytime at 316-683-0178.
Provider credentialing is the process of obtaining, verifying, and analyzing a practitioner’s qualifications to provide care or services at a facility/company/organization. All this is done to see if a provider is worthy of medical staff membership, enrollment into a network, or appointment to a position. Medical Staff Professionals (MSPs) must verify a practitioner’s professional credentials per their organization’s policies and hospital accreditation standards. Typically, credentialing documents include medical background checks for providers and much more. See more about facility provider credentialing here. Please contact us if you have any questions about credentialing services. We’re happy to help!
All providers are required to submit continue medical education credits (CME) to maintain their licensure. The number of requirements depends on the type of specialty and the entity that the license was approved through.
The Kansas Board of Healing Arts has a Category III CME requirement on the following: (1) Acute or chronic pain management; (2) the appropriate prescribing of opioids; or (3) the use of prescription drug monitoring programs. Each physician MUST have at least one CME credit in this category each year. If you have NOT completed the requirement for this year, please find more information to complete CE requirements online here.
The main purpose of CAQH is to complete the credentialing information one time through the universal electronic platform where insurance plans can assess it without bothering the provider. The data must be attested every 90 days, per the No Surprises Act that was implemented in 2022. The initial and re-credentialing applications can be processed using this platform.
An NPI number, known as a National Provider Identifier number, that is a unique 10-digit numerical identified that identifies an individual provider or a healthcare entity. Once assigned, this number is permanently tied to the provider throughout the medical career. Though primarily used for billing, it is also required for enrollment into the insurance companies.
Walk through the process of applying for medical credentialing services online with us. Our guide will help you navigate through initial applications, reappointment applications, and credentialing document updates.
While a 3-year reappointment cycle may bring about certain administrative benefits, extending the reappointment cycle may prolong the length of time before potential problem practitioners are addressed. Failure to conduct thorough, frequent assessments may lead to claims of medical malpractice or negligent credentialing. There are also implementation challenges and the transition can be lengthy. Time is needed to establish bylaw changes, internal policies and procedures, and communication with the medical staff members on the transition process. See our 3-year reappointment cycle blog for more.
The current Conditions of Participation recommend reappointment every 24 months. Medicare reimbursement could potentially be a consideration. It is also noteworthy that the Conditions of Participation do not require ongoing provider monitoring and focused provider monitoring throughout the term of medical staff membership. Not performing these monitoring activities routinely puts the hospital at risk for issues going undetected for an extended period.
MPR performs credentialing for several hospitals throughout Kansas and the Midwest. Transitioning from the 2-year reappointment cycle to the 3-year reappointment cycle will require the following:
- All providers cannot have privileges at any other participating facility that has a 2-year reappointment cycle.
- The facility must update the medical staff bylaws and internal policies and procedures to allow for a 3-year reappointment cycle.
- The facility has the responsibility for explaining the transition to their medical staff membership.
MPR sends the credentialing contact at the group several different forms to collect the data required for the group and the provider. Once the information is received, we use the information to complete applicable applications for insurance enrollment and hospital privileges. If you have any questions about client enrollment services or insurance enrollment management, please contact us and we’re happy to help answer them!
If you are retiring, relinquishing hospital privileges, or leaving a group, CLICK HERE to submit your deactivation request. If you are moving groups and will retain your hospital privileges, please submit the contact information for your new group and a new certificate of insurance to info@mprcred.com.
Our average turn-around-time (TAT) for processing an Initial Appointment Application is 30 to 35 calendar days from the time we begin a completed application. Some files take longer and some files (especially of a recent graduate) do not take as long to process. If preferred, the file may be released to the client for processing upon request with outstanding verifications sent under separate cover.
Yes, MPR will notify its facility clients of the applications being sent to its providers. The client will have the ability to request a packet not be emailed to a provider if the applicant is leaving the facility soon or reappointment is not necessary.
MPR will include clinical privileges if provided by the client for inclusion in the reappointment packet. Deadlines will apply.
The credentialing process is deemed a partnership between MPR and its clients. MPR records attach a provider to an address in its database that is consulted for reappointment packets, insurance enrollment, etc. Therefore, it is critical that clients keep MPR updated with the most current address information.
Communication is a key component to the success of any credentialing process. When a service agreement with MPR is signed, a credentialing contact is identified. Please contact MPR if the credentialing contact at your facility changes.
Reports can be requested as needed. The most common reports requested include a listing of practitioners currently found in the MPR database, the turn-around-time for a given time period (quarterly, annually, etc.) and a credentialing activity report that includes the initial appointment/reappointment/provider enrollment activity on all practitioners within a given time frame.
These initial and reappointment files can be accessed by the client on the MPR client portal under a password-protected section that is set up when you sign a service agreement with MPR.
Yes. Each Initial Appointment Application and Reappointment Application is verified through primary source contacts, therefore meeting all national accreditation and licensing standards.
Yes, we often have clients that want MPR to include facility-specific information (risk management plans, medical staff bylaws, confidentiality statements, etc.) in the initial appointment packets, reappointment packets or both.