Workers' Comp

What is Credentialing? Why Should I Care?

July 3, 2023

Lisa Robbins

Senior Director, Network Operations Management

According to the National Library of Medicine, credentialing simply is the process of assessing the academic qualifications and clinical practice history of a healthcare provider.  

Network credentialing is vital to ensure that all providers have the certifications and experience to deliver good quality care. Re-credentialing and ongoing monitoring, for network purposes, is the ongoing process to ensure that credentialed providers continue to meet the criteria for network participation. It is important to understand what credentialing is and realize that not all network organizations perform credentialing to the same extent, or at all. 

The Coventry Network is credentialed and re-credentialed by Verisys, a NCQA-accredited Credentials Verification Organization (CVO). For individual practitioners, the Coventry Credentialing Program secures primary source verification on the following elements: 

  • Licensure 
  • Board certifications 
  • Hospital admitting privileges 
  • Current professional liability coverage Drug Enforcement Agency (DEA) and state controlled-drug substance registration 
  • Disciplinary history or adverse actions 
  • Malpractice insurance claim history 
  • Relevant physical and mental health history 
  • Professional education and training 
  • Work history 

In addition to the applicable criteria listed above, facilities are reviewed to ensure: 

  • Good standing with state and federal regulatory bodies 
  • Applicable accreditations or CMS/State Surveys 

Verisys also performs ongoing adverse event monitoring for Coventry network providers. This monitoring checks for both federal and state exclusions and sanctions. An adverse event may result in immediate network termination or review by Coventry’s Quality Committee dependent on the nature of the adverse event. 

At Coventry, we take network management seriously. We want to do everything possible to ensure that the providers in our network have the education and experience needed when treating individuals who have experienced an injury or illness as a result of a workplace incident or automobile accident.  

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