Credentialing Services

Upper Peninsula Health Group (UPHG) Credentials Verification Organization (CVO) performs credentialing for all of the hospitals in the U.P., including Federally Qualified Health Centers, a Physician Hospital Network in Wisconsin as well as Upper Peninsula Health Plan.

Our Mission

The mission of the Credentialing Department is to ensure our network of health care professionals and organizational providers are qualified and meet current industry standards of credentialing, through a defined verification and monitoring process.

NCQA Certification

  • Every two years, our Credentialing Verification Organization (CVO) undergoes NCQA recertification. The CVO was originally certified in 2010 and recertifies every two years.
  • By becoming NCQA certified, management has a way to ascertain whether or not the department is meeting their mission, the company’s mission and that they are providing quality services for their clients and the health plan in order to help protect the people of the Upper Peninsula.

Services

The service we provide is Common Credentialing, meaning we can credential a single provider for multiple hospitals and the Upper Peninsula Health Plan (UPHP) at the same time to avoid having the provider fill out multiple applications. This also means that the provider is reappointed every two years for all of the facilities with a single application.

Summary of Services

If application is not complete, this may delay the timeline and possibly prevent participation in UPHP.   Corrections to update/complete omissions or errors will be requested, but need to be signed/dated by the applicant.

Name, date of birth, social security number, NPI, aliases, marital status, etc.

Primary practice specialty and subspecialty or specialties to be performed while at hospital.

All medical licenses, current and past are collected. Each one is verified via the state’s licensing department and reviewed for license sanctions.

Must be registered in the state the provider will be prescribing.     

Collect a Certificate of Insurance (COI) covering the applicant while working at the hospital (the source of this should also be listed on the RTC; coverage may be provided by the hospital, a locum company, or the applicant themselves). 

10 years of malpractice history is collected, this should match up with the affiliations provided, letters are sent to each requesting claims activity.

Letters are sent to hospitals and employers at appointment and reappointment to verify a practitioner’s current or prior affiliation with a hospital and evaluation of his/her competency.  It includes a two page questionnaire, “Facility Affiliation Verification Questionnaire” and a three page “Physician Evaluation”.  We send out a maximum of 10 affiliation letters, along with a signed/dated release, completed privilege list and photo ID.  Some hospitals will only return a form letter which verifies affiliation and states whether or not the practitioner is or was in good standing while on staff.

A reference letter is emailed or faxed to 3 peers (of greater or equal education) as listed by the applicant.

Verification of the completion of medical school, residency, fellowship and boards is usually done online via the American Medical Association (AMA), American Osteopathic Association (AOA) or National Student Clearinghouse (NSC).  This only needs to be done once for the life of the provider, since this information does not change from year to year.  In the event that there is data that UPHG cannot verify (sometimes the AMA is not current), then we go directly to the institution(s).  This might be done verbally or in writing.  If a practitioner has completed his/her training or education within the last 5 years, UPHG will send a competency questionnaire to the director of the program.

Verification of board certification for Medical Doctors (MDs) and Osteopathic Doctors (DOs) only, via the AMA, AOA, directly with the board itself or with an official designated display agent as determined by the American Board of Medical Specialties (ABMS) such as Certifacts.  UPHP requires board certification or proof that the provider is in the process or eligible to become board certified.

National Practitioner Data Bank (NPDB), Office of Inspector General (OIG), System for Award Management (SAM), Medicare Opt-out, MDHHS Sanctioned Providers, and LARA Disciplinary Action Reports.

  • Clinical activity/case logs/practice profile (24 months)
  • CME/CEU attestation
  • Photo ID
  • Hospital Release & Privilege list
  • Work history and explanations of gaps (6 months or more)
  • Attestation statements
  • National Practitioner Identifier (NPI) validation
Be sure to send your approval letters and/or board report to us right after the meeting. See Contact list to select the appropriate individual to email. Contact List.

 

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For questions call 1-906-226-4285 or email Credentialing Services.