Frequently Asked Questions

Medical Staff Services does not begin the credentialing or privileging process until an application is received. If the provider is not applying for Active staff, or for Health Professionals who will not be an employed provider, credentialing and privileging do not start until the privileges and letter of support form are signed and completed by the clinical department and returned.

The answer to this question varies, depending on the work history, training and education, and participation of the practitioner applying. In general, the process for a simple application with quick responses from all references and verifications can take 8 to 10 weeks from receipt of the application to presentation at the Credentials Committee.

Medical Staff Services has to get everything directly from the institution where it happened or the person providing the information (called primary source); foreign education, training or work experience, military experience, or verifications and references that need to be requested more than once prolong the process. Not having complete and correct contact information on the application also lengthens the credentialing process.

After all credentialing for medical staff membership and privileges is completed by Medical Staff Services, two committees review all new applications: Credentials Committee, and Medical Executive Committee. Each committee meets one time per month, and it takes one week between committees. Following committee review, Dr. Smith approves as the hospital's designated governing body. Medical Staff Services also must have the signed faculty appointment on file before activating privileges or finalizing the appointment letter. Committee review and faculty appointment can take anywhere from one week to several weeks to be completed.

Verifications from training, affiliations, and employment since obtaining a medical degree, peer references, negative or neutral comments made on verifications and references, verifications from state licensing, sanctioning entities, National Practitioner Data Bank, board certification (usually through ABMS), foreign medical school (through ECFMG, or primary source verification when necessary), malpractice coverage and claims histories, AMA Profile (when applicable), DEA verification, and competency data (when available) for privileges as requested and recommended.

All state licensed insurance companies and many networks are regulated to require credentialing of participating providers. HMOs are specifically regulated with regard to credentialing and follow regulatory standards. NCQA and URAC are accrediting agencies; primarily, they accredit managed care companies and other insurance payors. Delegated credentialing is the process by which these companies contract to accept the credentialing work of Medical Staff Services, and in turn, audit files annually to assure compliance with their regulations and standards. Regulations for NCQA and URAC are similar to, but not the same as, those for Joint Commission or DNV, and require more specific processes, documentation, and time frames to be compliant.

Medical Staff Services has altered some of its processes as regulations change to accommodate the flow of credentialing required by the UMAS payor agreements. For instance, under Joint Commission's accreditation, it was common practice for Credentials Committee to recommend a provider contingent upon a NYS license being issued; that process is not compliant with delegated credentialing or DNV regulations. Additional steps in the process are also required, such as initialing, dating, and tracking all documentation received, recording all changes to the provider file data, etc.

UMAS contracts with Medical Staff Services to achieve delegated credentialing with over 14 insurance companies or networks. Through delegated credentialing, the payor accepts Upstate University Hospital's credentialing process and primary source verification as a substitute for doing this work through the payor's credentialing office. Following the approval process for credentialing and privileging, and once UMAS declares the provider credentialed by submitting an updated spreadsheet to the payors, that provider can begin seeing and billing patients. The UMAS central office with the significant support of Medical Staff Services has actively pursued the achievement of delegated credentialing agreements with third party payors. An agreement is first reviewed by the UMAS office and then reviewed by the Medical Staff Services Director and contractual changes are made.

This collaborative project has enhanced some of the data and information in the provider files. This strong relationship also provided the basis of our successful transition to NPI that served both hospital and physician billing functions.

Insurance companies in NYS are allowed 90 days to process a "clean" provider application. This time frame, compounded with too many experiences of "lost" or misplaced applications and packets by the payors, mean that the actual time it takes for a provider to be able to see a patient, and bill and get paid for the visit, can extend to many months. The negative impact on MSG revenue is clear. There is one exception: For many plans, certain specific providers [i.e.: Emergency Medicine, Anesthesiology (except Pain management), Pathology, etc.] may not require separate credentialing to work in a hospital as they are considered 'hospital based providers', and therefore, the hospital credentialing suffices.

Graduate Medical Education (GME) asks for a copy of the diploma, an official transcript, and if the Resident is a foreign medical graduate, GME requests the original ECFMG (Education Certificate of Foreign Medical Graduate) certificate.

Human Resources (HR) collects the I-9, application, security form, and data sheet, then do the data entry and other activities to get the person hired here.

No one does primary source verification when a residency is begun here, and thus, no credentialing work that could speed up the credentialing or privileging process is done. Hiring a resident from UH may be slightly faster because Medical Staff Services can get a verification response from our GME office and corresponding data regarding credentials more quickly.

ECFMG certification is only deemed primary source verification for foreign medical graduates who graduated after 1986. ECFMG does not verify graduation prior to that, and does not verify postgraduate training or work experience from outside the United States.

Board certification, if not within the past year, is not deemed sufficient documentation of current competence, recent training, how often the procedure is performed by the provider, or when the provider last performed the procedure. For certain specific procedures, Medical Staff Services asks for case logs, letters from recent Chairs or program directors, or other proof of recent / current competence, before the privileges are granted. The information provided is reviewed by the chief of service or designee, and by the committees at initial or re- application.

There are questions and information requested on the application that a CV does not answer, and that are not addressed in the hiring process. In addition, some of the questions and information requested on the application meet specific requirements of regulatory agencies such as the New York State Department of Health, Joint Commission, or National Committee for Quality Assurance.

Not all applicants are employed, nor do all desire appointment to the Faculty at the College of Medicine, or College of Nursing. Beyond that, each entity is looking for different information to meet specific requirements.

The best thing the applicant can do is to provide a completed application with accurate fax numbers, addresses, contact names, and e-mail addresses.

The applicant should also practice a policy of full disclosure; if negative or possibly negative information is found and not disclosed, the process slows down quite a bit while Medical Staff Services does some investigating. Not providing complete information can completely halt the process.

When the practitioner receives correspondence, whether via e-mail or hard copy, listing what is still needed, returning those items to Medical Staff Services promptly will help ensure fewer delays in the credentialing process; originals are not needed and it is fastest to respond via fax or e-mail. Promptly call the assigned Credentialing Coordinator with questions about the items on the list.

Schedule the in-person or telephone faculty orientation with the Medical Director and / or Director of Peri-operative services as soon as the letter announcing the need for this arrives. Scheduling can be complicated, as these doctors also have patients to see, and other duties within the hospital to perform. Orientation must be scheduled before Credentials reviews the file.

Start the faculty appointment process simultaneously with the Medical Staff Services credentialing process. Once the practitioner is reviewed by the Credentials Committee, and recommended for approval to the Medical Executive Committee, the Faculty Appointments Specialist can move the faculty appointment to its conclusion. Faculty Appointments that are not started ahead of time are one of the top three reasons for a credentialing delay.

Finally, if you call your references and prior post-graduate training or affiliates to request that they respond to our letters, faxes, or e-mails, this often speeds up the response time from those facilities. Delayed responses are the number one cause of delays in credentialing.

• Complete the entire credentialing application, truthfully.
• Send the application, along with any of the documents you have as soon as possible; at least 12 weeks ahead of time*. (Do not wait until your license or DEA are issued)
• Look at your e-mail daily; coordinators communicate primarily through e-mail to reduce communication times.
• Submit a complete packet for your license application to the New York State licensing board and (if needed) FCVS paperwork; sending these in piecemeal often causes significant delays when documents are lost, dontt arrive, or are incomplete.**
• Start the Faculty Appointment process concurrent with the Medical Staff application.
• Contact your references and prior affiliations / places of employment. Let them know that Upstate University Hospital's Medical Staff Services will be getting in touch, and ask them to respond as quickly as possible.
• If you are asked for documentation for specific privileges you have requested, return it as soon as possible.
• Contact the assigned coordinator directly with questions - she will have the most updated, complete idea of what is still outstanding and where your application is in the process.
• Schedule your orientation; while it must be scheduled ahead of the Credentials Committee, it can take place after that date.

*Allows 10 weeks for credentialing, 1 week for committee review, and 1 week for governing body approval, faculty and medical staff appointment letters to be issued, and all computer systems to be activated.

** According to HANYS, a complete application for license can be processed in as little as two weeks.