tci Medicare Compliance & Reimbursement - 2003 Issue 8

Credentialing: SHRINK STINKS, PLAN THINKS, DEAL INKED

The misdeeds of a phony psychiatrist, the forthrightness of a health maintenance organization and a new enforcement approach from the Department of Justice culminated Feb. 13 in an approach to credentialing the feds are touting as a model for managed care organizations nationwide. The model credentialing policy ironed out between the office of Patrick Meehan, U.S. attorney for eastern Pennsylvania, and Keystone Health Plan East Inc., covers both the initial verification of providers’ licenses, education and board certifications, as well as provides for ongoing audits to ensure appropriate verification procedures have been followed. “We, like the officials...

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