GLOSSARY OF TERMS

CAH (Critical Access Hospital) – Most critical access facilities are CMS licensed.

CAQH (Council for Affordable Quality Healthcare) – is a not-for-profit organization focused on achievable, concrete initiatives designed to strengthen the nation’s health care system and make life simpler and easier for patients and their providers.

Clinical Competency – The ability to perform procedures in a proficient and competent manner.

Clinical Privileges – The process in which the organized medical staff evaluates and recommends an individual practitioner be allowed to provide specific patient care services in their healthcare facility within well-defined training criteria.

CMS – Centers for Medicare and Medicaid Services. https://www.cms.gov/

CVO (Centralized Verification Organization) – A centralized verification organization verifies provider information, such as medical school training and previous practice sites, on behalf of participating clients. This single verification system reduces costs and minimizes errors for credentialing queries while eliminating duplication of requests required of providers. CredentialingOne does not currently offer this service, but is in the process of getting certified.

CVS (Centralized Verification Service) – (see CVO)

Joint Commission – An independent not-for-profit organization, The Joint Commission accredits and certifies more than 19,000 health care organizations and programs in the United States. Joint Commission accreditation and certification is recognized nationwide as a symbol of quality that reflects an organization’s commitment to meeting certain performance standards

NPDB (National Practitioner Data Bank) – The National Practitioner Data Bank (NPDB) is a web-based repository of reports containing information on medical malpractice payments and certain adverse actions related to health care practitioners, providers, and suppliers.

NPI (National Provider Identifier) –  A Health Insurance Portability and Accountability Act (HIPAA) Administrative Simplification Standard. The NPI is a unique identification number for covered health care providers. It is a 10-digit number used for a variety of reasons in the health industry.

PECOS (Provider Enrollment Chain and Organization System) – PECOS supports the Medicare Provider and Supplier enrollment process by allowing registered users to securely and electronically submit and manage Medicare enrollment information.

Practitioner – A person engaged in the practice of a profession, occupation.

Primary Source Verification – Verification from the original source of a specific credential (education, training, licensure) to determine the accuracy of the qualifications of an individual health care practitioner.

Reappointment –  The process of re-evaluating a practitioner’s current competency after they have been appointed to the medical staff or professional staff.

Taxonomy codes – Administrative codes set for identifying the provider type and area of specialization for health care providers. Each taxonomy code is a unique ten character alphanumeric code that enables providers to identify their specialty at the claim level.

Turnaround-Time (TAT) – The time interval from time of submission to the time of completion of a practitioner’s credentialing file.

Request More Information