Application Process (12/05)

When new applications or reappointment applications are received, all information on the application is reviewed to be sure:

1. all necessary information has been provided, including complete address and telephone information.


2. all questions are answered (explanations for any "Yes" answers are requested and documented).


3. all necessary signatures have been obtained from applicant and are dated.


4. all necessary signatures have been obtained on the application and privilege delineation form indicating that the department chair and chief have reviewed and approved.


5. there is a current DEA license attached; (if applicable, i.e., pathologists and radiologists are not required to have one).


6. there is a current license attached (verified on the Internet with the Division of Occupational Licensing.) This site is also checked to be sure there are no disciplinary actions, citations or pending actions against the provider. (Additionally, the most current Disciplinary Action Newsletter is reviewed to be sure that the provider is not listed).


7. that a current copy of the practitioner's insurance malpractice face sheet is attached
   • Verification letters are sent to the insurance companies to verify malpractice coverage and documentation is requested if there are any malpractice claims - we go back ten (10) years on a new appointment and two (2) years on a reappointment. If there are claims, and the provider has not provided an explanation, he/she is contacted for an explanation and the information is kept on file.
   • Malpractice information is reviewed by Risk Manager.
8. there is a current UH Pharmacy Signature form signed and dated attached.


9. there is a current UH Hospital Consent form signed and dated attached.


10. there is a current attached and provided. (Started collecting CME as of 10/05)


11. there are no time gaps in the work history and schooling. (If there is a time gap, the physician is contacted to find out why and this is documented.)


12. Current health information has been obtained including documentation of annual TB test or clear chest x-ray if positive. (We ask for MMR/Hep B, but it is not a mandatory requirement in our credentialing process.)


13. Criminal Background Checks and Drug Testing are now required on all new physicians (as of 10/04)
    • Community Clinic Providers - Contact Paulette Alford (587-6308)
    • Attending Physicians covered by U of U malpractice - Contact Faculty Office - Jennifer Murphy (581-5705)
    • Courtesy Physicians not covered by U of U malpractice - Contact MSO - 587-6618


14. there is a current photo ID (like a driver's license, etc.) - (new apps as of 1/04 - reappts - as of 10/05)

After the information on the application has been keyed into CACTUS, primary source verification letters are sent out. Verifications include:

1. verification of all affiliations (ten (10) years on new applications and two (2) years on reappointments.
2. verification of all education including undergraduate degree.
3. 3 (three) peer reference evaluations are requested on new applications and 2 (two) on reappointments.
4. board certification is verified one of the following ways:
   • On line with Certifacts
   • On line with one of the following:
     • ABMS Internal Medicine Board
     • ABMS Pediatrics Board
     • ABMS Family Practice Board
   • Podiatric Board is verified via correspondence with the Board or on their website.
   • Osteopathic Boards are verified through the American Osteopathic physicians website.
5. The National Practitioner Data Bank NPDB) and Healthcare Integrity and Protection Data Bank (HIPDB) are queried on new application and every two years on reappointments for:
   • Medicaid/Medicare Sanctions
   • Healthcare fraud
   • Criminal actions
   • Malpractice information
6. The Federation of State Medical Boards (FSMB) is queried for any board actions on new applications and every two years on reappointments.
7. The Official State of Utah Sex Offender Register is queried.
8. The OIG website is checked for any exclusions.
9. Faculty Appointment is verified with the SoM Faculty Office.
10. Malpractice coverage is verified
11. If the provider will be providing moderate sedation, a note is sent advising that he/she needs to view the CD which is kept in the MSO office.

All applications must be completed within 365 days (NCQA requirement). The 365 day time period is from the date the application is signed to the date of the Credentials Committee approval. If the application is not completed within 365 days, an attestation must be obtained from the practitioner stating that everything in the original applications is still true and verified information, i.e., malpractice, affiliations, peer reviews must be redone.

Additionally on Reappointments the following information is requested.

1. UH QA/Case Variance reports
2. UH Medical Record compliance is checked through Medical Record deficiencies reports that have been received and entered into Cactus Program
3. UH Customer Service complaints and positive comments are collected online
4. 2 year malpractice history is requested. If there have been any malpractice claims within the last 2 year period, this information is reviewed by the UH Risk Manager
5. Clinical pertinence is collected if available
6. Utilization review information is collected if available
7. Compliance information is collected
8. Department Chairs & Division Chiefs are asked to review all information collected during credentialing process.

When credentialing information has been received, the department chair and division chief have approved the reappointment, the file is taken to Credentials Committee, Medical Board and Hospital Board (or the delegated Hospital Board SubCommittee for review and approval.

last revised: 12/05