ABSTRACT
When an managed care organization (MCO) payor organization allows prospective providers into the network, it must perform diligent credentialing to attempt to ensure that the providers are expected to provide good quality care. This means that a process by which the participants are allowed to perform within the scope of their training is evaluated thoroughly by those granting the privilege to do so, with whom that clinician shall be affiliated. A program of credentialing/recredentialing, whereby credentials should be reviewed every two years based on their original effective date with the Independent Practice Association, should be developed. When it comes time to recredential, recredentialing information should be requested by certified mail, return receipt requested. A good selection and retention program within any MCO should follow certain procedural guidelines, as there are numerous laws that impose responsibility upon those groups or entities that allow medical providers to “lay hands on” patients when the credentialing activities fall short of the necessary due diligence.
