About this Self-paced Training

NCQA Credentialing Accreditation and Certification Updates Self-paced

This online course helps credentialing professionals and contractors identify gaps for improvement and align services with those desired by potential contracting organizations. NCQA faculty and surveyors guide participants in addressing critical performance implications for credentialing practices. The course includes examples and lessons learned to help participants define, plan, and achieve excellence in credentialing. What they learn may help them avoid misconceptions and accurately perform their work.

Note: Each attendee must register as a unique participant, as required by the NCQA Terms of Use. Special rates are available for groups of more than eight participants.

NCQA Standards and Guidelines

This course provides training specific to the NCQA standards and guidelines titled "Credentialing/ Provider Network (CR/PN)."

Benefits and Resources

• ·   The NCQA surveyor’s perspective.
• Applied examples.
• Group breakout session.
• Presentation slides.
• Recording of live session.

What You Will Learn

• ·  Explain current modifications and updates to NCQA requirements.
• Recognize themes that span NCQA credentialing standards.
• Discuss the operational needs and opportunities implied by NCQA requirements. 
• Define attributes of exemplary criteria for credentialing.
• Describe an NCQA surveyor’s perspective on evaluating credentialing practices.
• Identify the appropriate NCQA program for organizations seeking Accreditation or Certification. 
  

Topics

• Internal Quality Improvement Process.
• Agreement and Collaboration with Clients 
• Protecting Credentialing Information.
• Credentialing Policies.
• Credentialing Committee.
• Credentialing Verification.
• Recredentialing Cycle Length.
• Ongoing Monitoring.
• Notification to Authorities and Practitioner Appeal Rights.
• Assessment of Organizational Providers.                                                                                                                                                                 

Who Should Attend

• Clinicians, directors, managers, specialists, coordinators who contribute to credentialing activities. 
• Consultants, contractors, delegates, vendors of health plans.
• Professionals in compliance or risk management.
•    Professionals in quality assurance/improvement or performance measurement.

Faculty

Renee Aird-Dengler, RN, MS, CPMSM, CPCS, FMSP

Renee is an Independent Consultant with specific areas of expertise in application processing, credentialing, privileging, enrollment, streamlining processes and procedures, and practitioner centric credentialing focusing on revenue enhancement, practitioner and staff satisfaction.

As a Senior Consultant HealthStream and Morrisey Associates, Renee worked with their credentialing database software clients to establish application and credentialing procedures, create policy manuals, streamline operations, processes, and enhance revenue.    

Renee is a Registered Nurse, holds a B.A. in Behavioral Science, an M.S. in Management, with dual certification from NAMSS: Certified Professional Medical Services Management (CPMSM) and Certified Provider Credentialing Specialist (CPCS).  In 2016 Renee was among the first 15 professionals awarded the NAMSS Fellow Designation (FMSP) which NAMSS describes as “the pinnacle of achievement and acknowledgment for the Medical Services Professionals, recognizing a career MSP who has made outstanding contributions to the profession through service as a leader, mentor and educator”. 

At the request of The Joint Commission (TJC), Renee developed the first program specifically designed for medical staff service professionals for the The Joint Commission.  She was clinical faculty for the TJC, served on several of its committees and is a surveyor for NCQA CVO and CR products.  Renee is co-author of the “Medical Staff Handbook”, a TJC publication.

She is a past chair of the National Association Medical Staff Services (NAMSS) Education Council.  Renee was a member of the NAMSS Board and past president of the Illinois Association of Medical Staff Services.  She was adjunct faculty with the National American University and taught the online course in Medical Services Management.  She co-authored the first CPCS (Certified Provider Credentialing Specialist) Prep Course and as an Instruction for NAMSS taught the prep course at the NAMSS Annual Conference for over 20 years.  She has presented numerous programs and seminars across the country for NAMSS, state and local chapters, TJC, has served as an expert witness, and as a consultant for acute care, managed care, and state organizations.

Albert “Irv” Koehler, RN, MBA

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.

Continuing Education

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 activity was planned by and for the healthcare team, and learners will receive 4.5 Interprofessional Continuing Education (IPCE) credit for learning and change.

This educational activity is approved for: 4.5 AMA PRA Category 1 Credit^TM  and 4.5 ANCC contact hours.

This live webinar grants 4.0 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.

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:
Renee Aird-Dengler, RN, MS, CPMSM, CPCS, FMSP

Albert "Irv" Koehler, RN, MBA

Additional Planning Committee Members:
Vince Pereira: None

This program was developed in part by NCQA staff.