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Introduction to NCQA's Credentialing Standards


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Self Paced
Expires May 31, 2024

This virtual course provides an in-depth explanation of NCQA's credentialing standards.

Bundle and Save! Click Here for the About Credentialing: Conquering the Requirements Bundle.

About this Self Paced Training

Introduction to NCQA’s Credentialing Standards

 Faculty will walk learners through a detailed explanation of each Credentialing standard and lead them through scenarios that are designed to mimic real-life credentialing scenarios. A demo of NCQA’s Interactive Review Tool (IRT) will be provided to guide learners through key steps for submitting documentation for the survey.

Notes:
•    Each attendee must register as a unique participant, as required by the NCQA Terms of Use.

Benefits and Resources

  • Presentation slides. 
  • Recording of live session.
  • IRT demo 
  • Scenarios for applied learning.

What You Will Learn

  • Explain the NCQA Credentialing Standards.
  • Identify appropriate credentialing and recredentialing documentation and operational procedures required to comply with NCQA Accreditation Standards.
  • Describe potential problem areas in the credentialing process.
  • Apply the NCQA Credentialing Standards to assist health organizations in the credentialing process.
  • Discuss and identify the credentialing differences between Health Plan, Managed Behavioral Health Organizations, Credentialing Verification Office and Credentialing Accreditation.

Who Should Attend

This course is geared towards individuals with one year of experience, or less; collecting, reporting, and acting upon credentialing data; or those who need a refresher, including:

  • Credentialing Specialists/Coordinators/Managers/Directors
  • Consultants
  • Provider Relations Specialists/Managers
  • Quality Improvement Managers/Directors
  • Quality Assurance Managers/Directors
  • Regulatory Specialists/Managers/Directors
  • Vendors/Contractors

Faculty


Candice Costello, BS

Candice Costello is Assistant Director, Accreditation Operations Projects, at NCQA. In this position, she provides expertise and direction for multiple projects to support operations. She identifies and supports improvement projects to enhance efficiency and reduce product delivery risk, and works across NCQA teams to identify and implement business processes to transition products from design to delivery. Ms. Costello also supports ongoing and annual system improvement efforts for NCQA’s Interactive Review Tool, and supports the development, testing and release of the NCQA’s File Review System. 

Ms. Costello continues to serve as Accreditation Survey Coordinator for organizations seeking Accreditation/Certification, and is an Administrative Surveyor for Health Plan Accreditation surveys. In her previous position as Senior Accreditation Manager with NCQA, she was Account Manager for three large corporate accounts.

Ms. Costello earned her BS in Health Services Administration from James Madison University.


Irv Koehler, RN, MBA, CPHQ, CPC

Irv Koehler is a health care quality consultant for the Koehler Quality Group, LLC. In this position, he is an NCQA administrative surveyor and provides consulting services to organizations evaluating and preparing for NCQA Accreditation/ Certification projects, risk adjustment validation for managed care organizations, education on quality improvement practices and outcome measure development and tracking.  

Mr. Koehler is also a registered nurse with active licensure in Florida and Tennessee, and certification in quality and medical coding. Previously, he was a quality improvement professional at AmeriHealth Caritas and BlueCross BlueShield of Tennessee.

Mr. Koehler has an MBA from the Florida Institute of Technology, a BS in Nursing from Florida Southern College, a BA in Psychology and an ADN from Purdue University.


Veronica Locke, MHSA

Veronica Locke, MHSA is a process consultant with the Health Care Service Corporation (HCSC) in Dallas, Texas. Prior to joining HCSC, Veronica was a consultant for The Mihalik Group, providing healthcare-related consulting services.  Her areas of expertise include quality assessment and improvement; credentialing; delegation; disease management accreditation/certification; population health management; multicultural health care. 

Veronica is the former Senior Manager of Accreditation Policy for the National Committee for Quality Assurance. She was actively involved in the development and maintenance of the standards and guidelines of NCQA's Accreditation and Certification programs, specifically Health Plan, Disease Management and Multicultural Health Care Distinction programs. As a member of the Policy team, one of her major responsibilities was to serve as a content champion when providing policy clarifications and trainings internally and externally. 

She received her Bachelor of Science Degree in Public Health from the University of Maryland, College Park and her Master of Health Systems Administration Degree from Georgetown University in Washington, DC.

Continuing Education

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In support of improving patient care, the National Committee for Quality Assurance is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), the American Nurses Credentialing Center (ANCC) to provide Interprofessional Continuing Education for the healthcare team. 

This educational activity is approved for a maximum of 5.5 AMA PRA Category 1 Credit™, 5.5 nursing contact hours and 5.5 ACPE contact hours.

The assigned universal program number: JA0004597-0000-23-007-H04-P. Upon successful completion of this program (attending the full session and completing a program evaluation), participants will access CPE Monitor on the ACPE website to locate and track their CPE statement of credit.

This live webinar grants 1.0 other Continuing Education Unit (CEU) points for PCMH Certified Content Experts.  
 * Please note – You must attend the entire program to be eligible for total number of contact hours.

NABP Credit Reporting 
If you are a pharmacist completing a course offering CPE credits, please notify NCQA through ncqa.org within 14 calendar days that you have completed a CPE course. You must provide the title of the course, your NABP identification number and your DOB (month/date) within the notification to NCQA. We also recommend you update your education.ncqa.org profile with your NABP identification number. 

Disclosure of Relevant Financial Relationships 

The National Committee for Quality Assurance (NCQA) endorses the Standards of the Accreditation Council for Continuing Medical Education which specify that sponsors of continuing medical education activities and presenters at and planners for these activities disclose any relevant financial relationships either party might have with commercial companies whose products or services are discussed in educational presentations.

For sponsors, relevant financial relationships include large research grants, institutional agreements for joint initiatives, substantial gifts, or other relationships that benefit the institution.  For presenters or planning committee members, relevant financial relationships include the receipt of research grants from a commercial company, consultancies, honoraria, travel, or other benefits, or having a self-managed equity interest in a company; or having an immediate family member or partner with such a relationship.

Disclosure of a relationship is not intended to suggest or condone bias in any presentation but is made to provide participants with information that might be of potential importance to their evaluation of a presentation.

Relevant financial relationships exist with the following companies/organizations:

Faculty:
Candice Costello: None
Irv Koehler: None
Veronica Locke: None

Additional Planning Committee Member:
Felicia Khaalid: None

This program was developed in part by NCQA staff.

This program received no commercial support.

Here is the course outline:

1. Resources

2. Recordings

3. Evaluation

4. Attestation

After completing all modules, you will be awarded a certificate that will include any continuing education credits (if applicable).

Completion

The following certificates are awarded when the course is completed:

Certificate of Attendance
Nursing Certificate
Pharmacy Certificate
Physician Certificate
CCE Other Certificate
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