A 385 page tool box of credentialing policies, procedures, competency criteria and core privileges with delineated privilege checklists for all physician specialties plus all licensed allied health professionals or nonphysician clinicians. Health systems, HMOs, PPOs, hospitals and medical groups use the Credentialing and Privileges Manual to design and implement exemplary credentialing and privileging programs for physician and non-physician clinical practitioners.

This manual is focused on criteria for the granting of core and delineated privileges for primary and specialty physicians and non-physician clinicians (often called physician extenders, allied health professionals or midlevel practitioners) such as Nurse Practitioners, Nurse Anesthetists, Nurse Midwives, Surgical Assistants, Psychologists, Therapists and Podiatrists.

Extensive and detailed example privileges are listed for each specialty in an easy-to-use checklist format. Resources include extensive references, web links. Continuously updated as new recommendations become available from specialty societies and other authoritative resources.

Preface:Introduction; Procedure credentialing vs core credentialing; JCAHO bylaws and other credentialing requirements; Standard of care for credentialing and privileging processes; Document handling

Credentials:Why credential?, Credentials Committee, Procedure credentialing vs. core credentialing; JCAHO Medical Staff By-laws requirements; Peer Review; Negligent credentialing; Economic credentialing; Bylaws and Credentials, Provider Credentials and Privileges - Policy and Procedures, Credentialing Processes, Recredentialing, Request for Provider Application - response letter, Request for Application, Application and related documents, Provider Release/Consent Form, Release of Insurance Information Form, Addendum to Provider Legal History Form, Applicant references; Evaluation Form/letter to send to applicant's references;, Application Process; Working Document For Coordinators Use, Letters/Forms To Verify Internship/Residency Training, Provider Application Credentialing Form Check Lists, Provider Letter re: Required Documents Between Credentialing Cycles, Providers, DEA Certification form, ADA implications for medical staff privileges, Release of appointment application to hospital medical staff for use by PHO or another external organization, Monthly ‘Hot Sheet’ Review - recommendation; High Risk Providers, Provider Sanctions, Criminal background checks, Public Law Title IV (HCQIA), National Practitioner Data Bank (NPDB); Practitioner Health Status Request Letter, Primary Verification by State Medical and Dental Boards, Web Sites for Online Verification by State and Specialty Boards

Voluntary resignation/Leave of Absence Policy; Adverse recredentialing or privileges determinations - fair hearing, Licensure Examination Scores – relation to quality of practice.

Peer (physician/physician and physician/staff) Evaluations - Physician - Physician Evaluation Procedures and Forms, Physician/Physician, Self-Evaluation and Physician/Staff Forms

Privileges: Introduction to Privileging, Requirements for the granting of privileges, Staffing plan, Limited privileges, Temporary Privileges, Emergency/disaster privileges, Proctoring, Board Certification, Competency, Core privileges, Request for privileges to perform a ‘new’ procedure; Volume considerations as a privileging criteria for procedures

Setting or Location for the Exercise of Surgical or Invasive Procedure Privileges; Monitoring Procedures Performed that Require Specific Privileges; Cross-Department Privileges by procedure (ECG interpretation, Swan-Ganz catheter insertion, vasectomy, sigmoidoscopy, hyperbaric oxygen therapy, amniocentesis, thoracotomy tube insertion and management, tympanocentesis, C-sections, endoscopies)

'On-call' cross-departmental privileges, Processing Privileges, Privileges Signature Sheet, Signature and Record Sheet for Granting Privileges, Loss of privileges due to inactivity; Privilege requests for new technology, devices or procedures; Volume considerations as a privileging criteria for procedures; Setting or Location for Exercise of Surgical or Invasive Procedure Privileges.

Delineation of Privileges: by specialty (core and detailed privileges lists and criteria are included for each specialty or subspecialty)

Anesthesiology:Core; Checklist plus detailed privileging criteria for: Conscious sedation, Resident competency by year of training link; Pain management; Anesthesiology Proctor Assessment Form; Anesthesiology web links

Cardiovascular/Thoracic Surgery: Core criteria; Privileges checklist plus resources

Critical Care: Core criteria; Privileges checklist plus resources

Cross-departmental privileges - core criteria

Dentistry and Oral Surgery: Core criteria; Privileges checklist plus resources and detailed privileging criteria for: Arthroscopy of the Temperomandibular joint

Dermatology: Core criteria; Privileges Checklist plus resource links

Disaster Medicine: Core criteria

Emergency Medicine; Disaster medicine: Core criteria; Privileges Checklist plus resource links

Family Practice: Core criteria; Checklist plus detailed privileging criteria for: Delineation of cross-departmental privileges including Conscious sedation, electrocardiogram interpretation, Swan Ganz catheter insertion, Vasectomy, Flexible sigmoidoscopy, Hyperbaric oxygen (HBO) therapy, Amniocentesis, Thoracotomy tube insertions and management, Cesarean section, Endoscopy procedures - diagnostic, therapeutic to include colonoscopy, snare polypectomy, variceal hemastasis, EGD, ERCP, esophageal dilation/stent placement, laparoscopy; 'On call'; Electrodiagnostic tests; Integrative or Complementary/Alternative Medicine

Hospitalists: General information. Credentialing and privileges based on specialty and current competence.

Internal Medicine: I, II, III, IV; Checklist detailed privileging criteria for: Core criteria for Allergy and Immunology subspecialty III/IV privileges; Core criteria for Endocrinology and Metabolism subspecialty III/IV privileges; Core criteria for Infectious Disease subspecialty III/IV privileges; Core criteria for HIV privileges; Core criteria for Nephrology subspecialty III/IV privileges; Core criteria for Rheumatology subspecialty III/IV privileges; Core criteria for Pulmonary Disease subspecialty III/IV privileges; Example delineation of privileges forms online; Resident competency requirements

Cardiology/Cardiovascular Surgery Subspecialty III/IV procedure privileges criteria: Checklist plus detailed privileging criteria for: Carotid endarterectomy; Cardiac Computed Tomography and Computed Tomography Coronary Angiography (CCTA); Direct current cardioversion, elective; Exercise treadmill test (Stress Test) privileges; Echocardiography, Stress Echocardiography privileges, references; Permanent pacemaker placement privileges; Impedance Cardiography; Percutaneous transluminal coronary angioplasty (PTCA) privileges; Cardiac catheterization; Intracoronary stent implant privileges; References for angioplasty, stents, cardiac catheterization; Percutaneous balloon valvuloplasty (PTV); Electrophysiology (EP), references; Cardiology/Cardiovascular procedure privileges - general references; Internal Medicine Web Sites - useful for credentialing

Hematology/Oncology: Core criteria; Privileges Checklist plus resource links

Neurology: Core criteria; Checklist plus detailed privileging criteria for: Electrodiagnostic testing privileges with resource links

Neurosurgery: Core criteria; Privileges Checklist plus resource links

Nuclear Medicine: Core criteria; Checklist plus detailed privileging criteria for: Nuclear Cardiology, I-131 Therapy with resource links

Obstetrics/Gynecology: Core criteria; Checklist plus detailed privileging criteria for: High-risk privileges; Obstetrical and Gynecological Ultrasound Examination Privileges; Laparoscopically Assisted Vaginal Hysterectomy, Colposcopy

Occupational Medicine: Core criteria; Privileges Checklist plus resource links

Ophthalmology: Core criteria; Privileges Checklist plus resource links

Orthopedic Surgery: Core criteria; Privileges Checklist plus resource links and Pediatric orthopedic surgery privileges

Otolaryngology/Head and Neck Surgery (ENT): Core criteria; Privileges Checklist plus resource links

Pathology: Core criteria; Privileges Checklist plus resource links

Pediatrics: Core criteria, Pediatrics, I, II, III, IV, V; Privileges Checklist plus resource links

Physical Medicine and Rehabilitation: Core criteria; Privileges Checklist plus resource links

Plastic and Reconstructive Surgery: Core criteria; Privileges Checklist plus resource linkss

Podiatry: Core criteria; Privileges Checklist plus resource links

Preventive Medicine/Public Health: Core criteria; Privileges Checklist plus resource links

Psychiatry: Core criteria; Privileges Checklist plus resource links

Behavioral Health Care Clinicians: Core criteria; Credentialing & Privileges: Checklists plus detailed privileging criteria for: Psychiatry, Psychology, Psychotherapist, Psychology Associate or Assistant; Psychiatric Nurse Specialist (Advanced Practice Nurse); Medical Social Work; Medical Hypnosis/Hypnotherapy Privileges, Addiction Specialist - core criteria and checklist; Biofeedback Privileges, Neuropsychological Testing Privileges, Therapy: Family and/or Marital Privileges for Psychology,

Radiology: Therapeutic Radiology: Privileges checklist plus detailed privileging criteria for: Diagnostic and Interventional Radiology (Criteria for Ultrasound Imaging, Cardiac Computed Tomography and Computed Tomography Coronary Angiography (CCTA); Discography, Core-Cut Breast Biopsy Privileges, MRI, Neuroradiologic Procedures, Neuroradiology Facility, Renal and Visceral Transluminal Angioplasty and Vascular Stenting, Peripheral and Visceral Arteriography, Arteriography/Angioplasty Facility, Kyphoplasty and Vertebroplasty; Percutaneous Nephrostomy,

Radiation Oncology: Core criteria; Privileges checklist plus detailed privileging criteria plus resource links.

Surgery: Core criteria; general: Checklist plus detailed privileging criteria for: Bariatric Surgery criteria; Criteria for Endoscopic Cholecystectomy, Laser procedures (all specialties); Laparoscopic gastric bypass; and Pediatric general, transplant surgery privileges

Urology: Core criteria; Privileges; Privileges Checklist; Laparoscopic nephrectomy;Tension-free Vaginal Tape (TVT) Procedure; Robotic assisted radical prostatectomy (RAP) and laser radical prostatectomy (LRP) procedures plus resource links

Other: detailed privileging criteria for: Pain Management; Telemedicine services; Ventilator management; High Frequency Oscillatory Ventilation (HFOV) and other procedures

Non-physician Clinicians or Allied Health Professionals: Credentials and Privileges - Introduction; Allied Health Professionals Staff Application Form; Credentialing Criteria for Allied Health Professionals; Authorization/monitoring of external agency or physician employees who provide healthcare services; Allied Health Professional Privileges Approval Sheet; Certification Statement by Supervising Physicians

Credentialing and Delineation of Privileges for Non-physician Clinicians by area of practice:Core criteria; Checklists plus detailed privileging criteria for: Audiologists; Blood bank technologist; Nurse Practitioners, Standardized Procedures for Nurse Practitioners (Immediate/Urgent care); Chiropractors; Doulas; Optometry; Pharmacist, clinical; Podiatrists

Behavioral health providers: Refer to the preceding list

Physicians Assistants: (PA, Hospital-Related Services, PA, Ambulatory Care Privileges, PA, Notification of Privileges Form); Medical Assistant; Surgical Assistant; Certified Registered Nurse Anesthetists (CRNA); Certified Nurse Midwives (CNM); CNM Job Description; Licensed Vocational Nurse (LVN/LPN), Scope of Practice; Registered Nurse, Scope of Practice; Nurse/Physician Assistant - Endoscopy; Case Manager (CM); Nutritionists; Physical Therapists; Occupational Therapists; Speech-Language Pathologists; Ultrasound Technicians; Safety Officers; Cardiology technicians/assistants; Electrodiagnostic technicians; Volunteers; Therapeutic Yoga; Acupuncturists.

Provider Relations and Credentialing: Coordinator Position Description; NCQA Credentials Verification Services Certification Criteria List

Credentialing Software and Services: - lists of vendors and contact information.

References and Resources: In addition to references and resources related to credentialing and privileges, this section includes a site visit or survey credentialing tool in a check-list format for physician offices and facilities plus an authorization and release form for medical office site visits; Case law references for credentialing. Web site links related to medical staff bylaws, credentialing and the granting of privileges, performance appraisal, and peer review

This comprehensive resource was written by Dr. Margaret Bischel, FACP, a former chair of the Credentials Committee and medical staff president at a major teaching hospital in Chicago; subsequently a health plan medical director and finally a medical director for a large medical group practice with many health plan contracts.