1. CREDENTIALING MANAGEMENT IN THE ELECTRONIC HEALTH RECORD
Marina C. Jimenez, RDH, MHA
Director of Quality Assurance
The Herman Ostrow School of Dentistry
CREDENTIALING MANAGEMENT IN THE ELECTRONIC HEALTH RECORD

2. What is credentialing?
Credentialing is a systematic approach to the collection and verification of providers professional qualifications, such as:
Relevant training
Licensure
Certification, and/or registration to practice in a
healthcare field
Academic background
Assessment of whether the practitioner meets certain criteria relating to professional competence and conduct

3. Clinical Committee Structure
CLINICAL PRACTICE COMMITTEE
QUALITY PROCESS IMPROVEMENT SUBCOMMITTEE
COMPLIANCE AND CREDENTIALING SUBCOMMITTEE
PROFESSIONAL STANDARDS AND POLICY SUBCOMMITTEE

4. Compliance and Credentialing Sub-committee
The Compliance and Credentialing Sub-Committee will, under the oversight of the CPC:
review and act upon all information received during the credentialing and re-credentialing process as defined by the School’s policy for the granting, renewing, changing or terminating a practitioner’s clinical practice privileges;
oversee the implementation of the School’s compliance program developed as part of the University's Healthcare Compliance Program.
Membership:
The membership of the Compliance and Credentialing Committee (CCC) is approved by the Dean and shall be comprised of representatives from each of the clinical divisions and the Compliance Officer who shall constitute the voting membership.
Also represented on this committee in the status of ex-officio members are the Director of Faculty Affairs, Director of Quality Assurance, Director of Healthcare Compliance; Director of Clinical Financial Services; Manager of Electronic Health Records/axiUm and the Assistant Vice President of Healthcare Compliance for the University.
Additional faculty and campus representatives can be added as deemed necessary by the chairperson of this committee and as approved by the Dean. Appointments shall represent a balance of clinical programs.
Terms will be two years or as otherwise determined by the Dean.
Meetings:
The Compliance and Credentialing Sub Committee will meet at minimum once a month. Additional meetings may be called by the chairperson with at least 72 hours advanced notice.
Voting:
All faculty members of the Compliance and Credentialing sub-committee may vote. Non-faculty members are considered ex-officio members and are non-voting members.
Quorum:
A majority of the voting members constitutes a quorum

5. Various credentialing components
_______ Completed Application
_____ Current CA License (s) relative to job function (Primary Source Verification)
_____ Current CPR Certificate
_____ Current DEA Certificate (When Applicable)
_____ Curriculum Vitae
_____ Health Screening for TB / Hepatitis
_____ On-line Compliance Education
______ HIPAA Certificate
______ OIG Exclusionary Check
______ Signature Verification Form
______ National Practitioner's Database Check
______ Primary Source Verification of Work Experience
______ Compliance Member in Good Standing Memo

6. Personnel database
‘Access’ database maintains all Human Resource information
Houses: Personal information, clinical status (i.e., patient care, pre clinical), all licensures and certifications relative to job function, credentialing dates, date of hire
Manages reminders to providers at 90, 60, 30 day intervals regarding upcoming credential expiries or EXPIRED (cc to appropriate personnel as well as QA office)
notifications also sent when Personnel database updates the provider profile relative to licensure and certification (cc to appropriate personnel as well as QA office)

7. axiUm: The Ostrow School of Dentistry Electronic Health Record
Under the direction of faculty, students and residents enter treatment and documentation relative to patient care in the EHR
Faculty who oversee the student and resident treatment ‘approve’ documentation by swiping their personal axiUm ID card indicating approval
The axiUm ID card is tied directly to the expiry set up in the axiUm user profile

8. axiUm User profile

9. User Certification/ Credential profile

10. User Certification / Credentials Information and Codes

11. Certification/Credentials Management

12. The credentials may vary and access to areas of EHR dependent on licensure

13. Credentials expired

14. Credential expiry reports

17. Quality delivery of Care Decreases liability
Credentialing
Management
Quality delivery of Care
Decreases
liability
Maintains regulatory guidelines

18. In summary…
Effective credentialing policies and procedures tied into the electronic health record (EHR), demonstrates commitment to excellence in delivery of quality care as well as compliance in credentialing.
Modules within the EHR assist in managing and provide support to ensure provider credentials are current and valid in order to supervise care.
The benefits of the EHR do not stop at patient care.

19. Questions?