Attestation Statement (NAMSS Comparison) Flashcards
ATTESTATION STATEMENT: CR3 Element C factors 1-6 Practitioners complete an application (and reapplication) that includes an inquiry regarding illegal drug use and inability to perform essential functions, history of loss or limitations of licensure or privileges or disciplinary actions, current malpractice coverage, and felony convictions. Attestation must indicate that the applicant personally attests that the application was correct and complete when they applied to the organization. If a copy of an application from an external entity is used, it must include an attestation to the correctness and completeness of the application. This accreditation does not require the attestation to be received prior to the organization conducting credentialing verifications and queries required for other elements. CR 1 Signature can be faxed, scanned, digital, electronic, or photocopied. Use of signature stamp is not allowed unless the practitioner is physically impaired and the disability is documented in the credentials file. If State regulations require an application not containing an attestation, an addendum to the application for the attestation must be used unless State regulations prohibit. CR 3 Time Limit: must be signed within 365 days (MCO) / 305 days (CVO) of the credentialing decision
a. URAC
b. NCQA
c. TJC (CAMH)
NCQA
ATTESTATION STATEMENT: Responsibilities for credentialed practitioners must include: participating in Medical Staff functions, committee activity, educational, and Quality Assessment / Performance Improvement (QAPI) activities; abiding by bylaws, rules, and regulations; and adhering to ethical practice guidelines. Practitioners must attest to the above listed responsibilities at appointment and reappointment which is verified during the survey process
a. Medicare CoP
b. URAC
c. ACHC (HFAP)
ACHC (HFAP)
ATTESTATION STATEMENT: The application includes a signed and dated statement attesting that the information submitted with the application is complete and accurate to the practitioner’s knowledge. Electronic signature is acceptable. Written policies and procedures should establish controls and manage risk for electronic signatures. Examples of acceptable signatures include faxed, digital, electronic, scanned, or photocopied signatures. Time limit: must be signed and dated no more than 180 days prior to the credentials committee review
a. TJC (CAMH)
b. ACHC (HFAP)
c. URAC
URAC
ATTESTATION STATEMENT: The application / reapplication must have a formal statement releasing the organization from any liability in connection with credentialing decisions and includes the applicant’s attestation to the accuracy and completeness of the application and the information provided and the applicant’s dated signature. The application includes a written attestation and the following information: professional liability claims history; refusal or cancellation of professional liability coverage; licensure revocation, suspension, voluntary relinquishment, licensure probationary status, or other licensure conditions or limitations; complaints or adverse action reports filed against the applicant with a local, state, or national professional society or licensure board; denial, suspension, limitation, termination, or non-renewal of privileges at any hospital, health plan, medical group, or other health care entity; federal actions or sanctions including DEA and Medicare / Medicaid; Conviction of a criminal offense (other than minor traffic violations; Current physical, mental health, or chemical dependency problems that would interfere with an applicant’s ability to provide high quality patient care and professional services. Verify on an ongoing basis; at a minimum, at expiration, appointment, and re-appointment
a. AAAHC
b. ACHC (HFAP)
c. URAC
AAAHC
