Regulatory and accreditation body verification requirements for managed care credentialing

The purpose of the verification process is to ensure that the information provided by the applicant is accurate and to determine whether the applicant’s credentials meet the organization’s criteria, as outlined in its policies. Verifications are performed at both initial credentialing and recredentialing, although only those elements subject to change (e.g., licensure) are required to be reverified at recredentialing. This table summarizes the various credentialing elements that must be verified through an appropriate source (either primary or secondary source accepted) and the associated time frames required by the regulatory and accreditation bodies impacting managed care credentialing.

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