Credentialing

The Credentialing process is a system for validating and evaluating the credentials and competencies of licensed and certified staff as a basis for employment, continued employment, or change in assignment.

Centro San Vicente has implemented a credentialing program to qualify for Federal Tort Claims Act (FTCA) liability coverage by credentialing their licensed and certified healthcare practitioners. While JCAHO only requires licensed independent practitioners to be credentialed, the FTCA requires that all licensed and certified staff be credentialed and recredentialed for the services that they perform in the Center. The Medicaid program requires that staff be credentialed based on services performed.

In order for a person to be covered by the FTCA, the licensed or certified individual must be a licensed, certified, registered or contracted staff member of the Center and must provide services consistent with the funding contract of the Center.

During the credentialing process, the following documents will be reviewed, verified and validated.

• Application
• Verification of education or training
• Completion of internship, residency or fellowship, if applicable
• DPS/DEA registration, if applicable
• License or certificate to practice in Texas
• Professional certification, if applicable
• National Practitioner Data Bank/Health Integrity and Protection Data Bank, if applicable
• Federation of State Medical Boards, if applicable
• Prior Liability Insurance
• Past or pending civil lawsuits and criminal proceeding for counties resided
• Professional reference
• Previous employment
• Verification of Fitness

After the credentialing process is complete, the Credentialing Coordinator delivers an original verification of documents, along with a summary of findings, to the Chief Medical / Dental Officer. All Licensed Independent Practitioners, i.e., health providers, credentials and findings are then presented to the Board of Directors via the Executive Director for Initial Appointment or Reappointment. Other licensed, registered or certified staff member’s summary of findings will be presented to the Chief Clinical Officer and Chief Executive Officer to approve or deny employment. This process should not take more than 120 days.

In order to maintain compliance with the Center, JCAHO, FTCA, PHS, Medicaid, Medicare and Managed Care contracts, current licensure must be maintained at all times.

It is the responsibility of the licensed, certified or registered employeeto maintain their licensure current and present a copy of the renewed license to the Human Resource Director and the Credentialing Coordinator.

Continuing education certificates must also be presented to the credentialing coordinator, as received.

Recredentialing for all licensed, certified and registered staff is performed every two years.