Credentialing

PBCP Services, LLC received NCQA Certification for 10 out of 10 verification services and meets NCQA's credentialing standards for health plans.

PBCP’s credentialing team will ensure that your organization's credentialing files are completed with accuracy and in compliance with regulatory standards, so you can rest easy knowing your organization is in good hands.  

With customizable user-friendly reports, and 24/7 access to your data, you’ll be able to know in real-time where your organization’s providers are at in the credentialing process. 

In addition to CVO services, PBCP also offers assistance with mock audits and preparation for pending audits from different accrediting bodies such as The Joint Commission, AAAHC, NCQA, and more.

Currently, PBCP maintains approximately 3000 physician, dentist, and other healthcare provider credential files. The vast majority of practitioners maintained in PBCP files are physicians (MDs/DOs).   These files are processed for initial credentialing and recredentialing for PHO’s, hospitals, health care network, clinic, surgery center, federally qualified community health centers, public health service, and home health clients throughout the U.S.

PBCP follows the credentials verification standards set by the National Committee on Quality Assurance (NCQA) for managed care organizations, the Joint Commission for hospitals and surgery centers, and Accreditation Association for Ambulatory Health Care (AAAHC) for surgery centers.  Some hospitals define higher credentials verification standards through medical staff bylaws than those required by Joint Commission. PBCP works with clients to meet the higher standards whenever possible.

In addition to application processing and primary source verification, PBCP monitors expiring documents and licenses (DEA registration, insurance certificate, licenses) and obtains new documentation from providers.  Also, PBCP monitors the HHS Office of Inspector General Medicare/Medicaid sanction reports and state licensing board disciplinary actions and notifies clients of any adverse information regarding practitioners on their current rosters.

Health care organizations delegate both the responsibility and liability for credentials verification, including National Practitioner Data Bank through a formal written contract for services. PBCP maintains professional and general business liability insurance for the protection of its clients.

PBCP provides reasonable access to its operations and files by clients for auditing purposes.  Staff is available to meet with organization committees and officers on an as-needed basis. 

  • Coordinate and oversee licensure maintenance and expiration dates (medical, DEA, DPS, malpractice insurance) including notification to providers before expiration. (Provider is responsible for actual completion of the required renewal)
  • Maintain providers CAQH account and attest so file will stay current. This also includes submitting updated licensure and malpractice face sheets
  • Maintain provider credentials files according to applicable state applications, to include all personal, licensure, and demographic information
  • Complete reappointment applications and complete paperwork requests for hospital membership and privileges
  • Complete re-credentialing documentation for health plans
  • Act as a liaison between the provider and the hospital and/or health plans
  • Below are the services we provide under this program

PBCP collects all information from Primary Sources and ensures that all provider data is verified and in accordance with the Joint Commission, NCQA, AAAHC, and other regulatory standards. The following items are verified according to an organization's bylaws: 

  • License to Practice
  • Work History
  • DEA
  • Board Certification
  • Medical Education
  • Malpractice Insurance Coverage
  • Application Processing
  • Sanctions against licensure
  • Medicare/Medicare Sanctions
  • NPDB Query
  • Malpractice Claims History
  • Hospital Affiliation Verification/Work Site Verification

Sanctions are disciplinary actions imposed against licensed providers and can have far-reaching consequences. OIG guidelines clearly state that healthcare organizations cannot employ sanctioned or excluded individuals. If an organization fails to disclose any excluded providers employed, the organization can be fined upwards of $100,000 per excluded employee. Now, more than ever, it is exceedingly important for organizations to take proper action to monitor their providers for sanctions and exclusions.

PBCP helps healthcare organizations maintain compliance by identifying through The Office of the Inspector General: U.S. Department of Health and Human Services (OIG), The General Services Administration (GSA), and The Department of the Treasury (OFAC), on a monthly basis, providers who have been sanctioned or excluded from participation in state and federal healthcare programs. Potential matches are investigated by PBCP and results are returned to your organization immediately for processing.

Expiration dates of time-sensitive credentials are monitored and updated on an on-going basis. Reminders are sent to providers on a client customized timeline. (120, 90, 60, 45, 30, 15 day marks are all options)

  • Primary State license
  • DEA License
  • CSR
  • Malpractice Insurance
  • Board Certifications
  • CPR
  • Driver License
  • CSR License
  • Hospital Reappointment Dates- No limit to hospitals tracked.
  • And many more, as required

Confidentiality and Privacy

PBCP maintains credentialing information under the strictest confidentiality policies.  Once we receive your information, we only release it to those healthcare organizations you authorize in writing.