GENERAL QUESTIONS
What is credentialing?
Credentialing is a term that usually encompasses two separate processes: credentialing and privileging.
Credentialing: Primary source verification of a health care practitioner’s education, training, work experience, license, etc. A variety of resources are used to verify the information involving direct communication from the educational and training institutions, past and current hospital affiliations and employers, peer reference letters, certification boards, licensing agencies and other sources.
Privileging: Granting approval for an individual to perform a specific procedure or specific set of privileges based on documented competence in the specialty in which privileges are requested.
Who is credentialed?
Each individual working in the hospital or clinic setting must be either: 1) credentialed through a Blessing Hospital medical staff process; or 2) employed by Blessing Hospital through a Human Resources process. Therefore, an individual must be credentialed, if not employed by Blessing Hospital.
Practitioners who are independently responsible for patient care by virtue of their license and hospital authority must be credentialed even if they are employed by Blessing Hospital. Licensed independent practitioners who must be credentialed regardless of whether they are Blessing Hospital employees or not are physicians, dentists, certified nurse midwives, podiatrists, nurse practitioners, physician assistants and psychologists.
Why does Blessing credential?
Blessing Hospital, like other health care organizations, is legally responsible for knowing that individuals providing patient care are qualified and competent to do so. Over the past 30 years there have been multiple legal cases where hospitals were held accountable because they had not done adequate credentialing.
The Joint Commission, The Centers for Medicare and Medicaid Services (CMS), National , Illinois Department of Health and Human Services and other oversight organizations require that members of the medical and allied health staff be credentialed and privileged before working in the facility.
Can a physician or other practitioner work before completing the credentialing process?
No. It is Blessing Hospital’s legal obligation to ensure that all practitioners have gone through the credentialing process and have been approved by the Board of Directors to work at a Blessing Health System entity.
A practitioner working at a Blessing Health System entity before the credentialing process is complete places Blessing Health System and the practitioner at legal risk and can directly impact the organization’s accreditation status.
What about medical students, residents and fellows?
Any medical student, resident or fellow who is in a training program affiliated with Blessing can work in the facility without being credentialed as long as their practice does not fall outside the scope of their current training program.
Physicians in training who wish to moonlight outside of their residency or fellowship program must be credentialed. For example, a Cardiology fellow who plans to moonlight as an internist must be credentialed for internal medicine privileges.
How do I know if I am currently credentialed with a Blessing entity?
Contact Blessing Hospital Medical Staff Services at 217-223-8400 ext. 6610.
How does a practitioner get credentialed and request privileges at a Blessing entity?
For information on the online credentialing application, privilege forms and application checklist, see How to Submit an Application.
Does Blessing Hospital require an application fee?
Initial applications require a fee of $200. Payment may be made by check or credit card and must be received by the Blessing Hospital Medical Staff Services before the application is processed. The Application Fee Payment Form is included in the Initial Credentialing Application Packet, see How to Submit an Application.
How does a practitioner submit a name change or office change to the Blessing Hospital Credentialing Office?
Complete the practitioner change form and submit it to the Blessing Hospital Credentialing Office.
What is The Joint Commission?
The Joint Commission is an accrediting organization with a mission to improve the safety and quality of care provided to the public.
Hospitals voluntarily submit to The Joint Commission accreditation surveys every three years; the survey is a comprehensive evaluation of the overall quality and safety of the organization.
Blessing Hospital Medical Staff Services complies with all of The Joint Commission credentialing standards.
INITIAL APPLICATION QUESTIONS
How far in advance of my start date should I begin the credentialing process?
Most health care organizations advise submitting an application 90 days before a practitioner’s start date.
The average processing time is less than 90 days. Ninety days is a benchmark because it allows extra time when verification sources do not respond in a timely manner or clarification of discrepancies is required.
How long does it take a practitioner’s application to go through the credentialing process?
Credentialing consists of two steps: 1) verification process performed by the Blessing Hospital Credentialing Office; and 2) review of the verified application by the Blessing Hospital entity’s Medical Staff and approval by the entity’s Board of Directors (entity = hospital, clinic, or other contracted entity).
An application can be completed in less time if peer references and other verification sources promptly respond to Blessing Hospital’s requests for information, requested documentation is supplied by the applicant in a timely fashion and there are no red flags identified in the application process which requires further investigation.
Credentialing time frame
Offices such as ours that perform primary source verification of credentialing applications have very little control over process time. The process time is affected by verification sources (other hospitals, training programs, peer references, employers, etc.) responding to our requests for information.
The verification process could be done in 2-3 weeks if all sources respond to first requests for information. If a response is not received, credentialing staff execute additional requests to sources. This causes a significant time delay in completing applications.
Is there anything a practitioner can do to speed up the application process?
Yes. Practitioners can greatly influence the length of processing time by contacting their verification sources and asking each source to mail or fax Blessing Hospital’s verification requests back as soon as possible.
When we start processing an application, the practitioner and their credentialing contact receive a letter from our office listing of all verification sources from which we require responses. We ask the practitioner or their credentialing contact to call the sources to prompt responses back to Blessing Hospital. Responses can be faxed or emailed to our office at (217) 223-0610, or MedicalStaffServices@blessinghealthsystem.org.
What happens if the application submitted is incomplete or missing required attachments?
Blessing Hospital only processes complete applications.
All incomplete applications are returned to the practitioner or clinic for completion; this creates a substantial delay in the practitioner credentialing process.
Use the Initial Application Checklist as a guide to identify what forms need to be submitted. See How to Submit an Application for detailed information.
What is Primary Source Verification (PSV)?
PSV is the process of verifying credentials directly with the source. For example, a credentialing office cannot accept a copy of a medical school degree as evidence that the physician graduated from medical school. The school must be contacted directly to verify the physician’s attendance and graduation.
PSV is required so that hospitals and credentialing offices do not receive fraudulent documents from applicants or other non-primary sources.
A credentialing office cannot accept any verifications that come through a third party rather than the primary source.
PSV is a requirement by accrediting bodies as well as the cornerstone of a good credentialing process.
How do I submit a credentialing application?
See How to Submit an Application.
If I am already on staff at a Blessing entity, how do I apply to another Blessing entity?
See How to Submit an Application.
If I am already on staff at a Blessing Hospital, how do I request additional privileges at that entity?
See How to Submit an Application.
PRIVILEGE FORM QUESTIONS
What are privilege forms?
The Joint Commission accreditation standards require Hospitals have privilege forms that indicate the type of care, treatment and services, or procedures that a practitioner will be authorized to perform.
Upon applying for initial appointment or reappointment, practitioners complete a privilege form indicating what privileges or procedures they want to perform at Blessing Hospital.
Blessing Hospital’s privilege forms include two types of privileges: (1) Core Privileges are those clinical activities within a specialty or subspecialty that any appropriately trained, actively practicing practitioner would be competent to perform. Practitioners that meet the threshold criteria for the specialty are qualified to request core privileges; (2) Special Request Privileges are privileges granted to some, but not all, practitioners in a specialty. These are privileges requested in addition to requesting Core Privileges and are procedures that require additional training or special competence. Additional documentation is required to demonstrate competence within the past two years.
How are privilege forms developed?
Medical Staff Services researches criteria/qualifications/initial and reappointment requirements for a specialty and requests practitioners of that specialty to review and make recommendations as appropriate.
Requests for privilege form revisions are reviewed by the Department Chairperson, Credentials Committee, Medical Executive Comimittee, and Board of Trustees for final approval before being amended.
Do I have to complete more than one privilege form if applying to multiple Blessing Health System entities?
Yes. Blessing Hospital and Illini Community Hospital are part of the same health system, but have separate Medical/Advance Practice Professional Staffs and Bylaws/Policies.
Why do I have to submit documentation of cases performed when I have already been granted the privilege to perform the procedure?
The Joint Commission accreditation standards require that hospitals determine a practitioner’s current competency at reappointment.
Blessing Hospital’s privilege form format identifies special request privileges as those that require additional documentation of competence.
Documentation criteria and privilege forms are established by the Medical Staff.
How do I obtain a case list of procedures I've performed at a Blessing Hospital?
To obtain a case list of procedures performed at Blessing Hospital, you can request this by emailing MedicalStaffServices@blessinghealthsystem.org.
REAPPOINTMENT QUESTIONS
What is Reappointment?
Reappointment is the process of re-evaluating a practitioner’s qualifications/current competency to provide care of services in or for a healthcare organization after they have been appointed to the Medical or Advance Practice Professional Staff.
Once I’m on staff, why do I need to go through the paperwork again?
The Joint Commission hospital accreditation standards require all practitioners to complete a reappointment process every two years.
Blessing has a duty to ensure that all practitioners on staff are currently competent; reappointment is the process of re-evaluating competency.
What happens if I don’t complete my reappointment paperwork?
The Joint Commission accreditation standards require all practitioners to complete a reappointment process every two years.
If a practitioner does not complete reappointment paperwork on time, the practitioner’s reappointment will expire and they can no longer provider care of services in or for Blessing Hospital.
If a practitioner’s reappointment expires, the practitioner must complete the initial application process in order to be appointed to the Medical or Advanced Practice Professional Staff and to provide care of services in or for Blessing Hospital.
How can I get more information on the Reappointment Process?
Please contact Medical Staff Services via email at MedicalStaffServices@blessinghealthsystem.org or call (217) 223-8400 ext. 6670
EXPIRABLES QUESTIONS
What are Expirables?
At Blessing Hosptial, expirables include a practitioner's:
- License to practice
- Malpractice insurance
- DEA certificate
- Board certification
How can I get more information on the Expirables Process?
Please contact Medical Staff Services via email at MedicalStaffServices@blessinghealthsystem.org or call (217) 223-8400 ext. 6672