Temporary Privileges/Provisional Credentialing

Question 1

TJC
Temporary Privileges/Provisional Credentialing

Answer 1

The CEO or designee, upon recommendation of the president of the medical staff or designee, may grant temporary privileges, in two cases
1. Urgent patient care need for a limited period of time as defined by the organization, after current licensure and competence are verified. While not specifically listed in the standard, any time privileges are granted the NPDB must be queried.
2. New applicants awaiting medical staff review and approval after verification of the following, not to exceed 120 days:
- current licensure
- relevant training or experience
- current competence
- ability to perform the privileges requested
- other criteria required by the medical staff bylaws
- a query and evaluation of the NPDB information
- a complete application
- no current or previously successful challenge to licensure or registration
- No subjection to involuntary termination of medical staff membership at another organization

Question 2

NCQA
Temporary Privileges/Provisional Credentialing

Answer 2

NCQA standards do not reference temporary privileges, but they do have a process for provisional credentialing.
An organization may conduct a one-time provisional credentialing of practitioners who are applying to the organization for the first time, prior to initial credentialing. The organization may not hold practitioners in a provisional status for more than 60 days.
Provisional credentialing files must be valid and verified within the specific time frames. They must contain evidence of the approval of the medical director or equally qualified practitioner (must be a physician) if the file meets the organization’s definition of a ‘clean file’; or they must be presented to the Credentialing Committee for review and consideration for participation into the network.
The following criteria must be met prior to the decision to grant provisional credentialing:
- PSV of license
- written confirmation of the past five years of malpractice settlements obtained from the malpractice carrier of NPDB query
- the application must be current and include attestation

Question 3

ACHC Acute Care Hospitals
Temporary Privileges/Provisional Credentialing

Answer 3

Bylaws provide for the granting of temporary privileges:
- during review and consideration of application, after completion of process for files waiting to be presented to MEC and governing body
- for care of specific patient/s
- for locum tenens
- for times of emergency or disaster
Privileges are granted upon recommendation of the chief/chair of a department or service and the CEO of the facility or designee who is acting on behalf of the governing body. They must be time-limited and taken only when sufficient evidence exists that the granting of temporary privileges is prudent.
Granting of temporary privileges occurs only after verification of licensure, DEA, insurance, and at least on recent reference from a previous facility, chief, or department chair. Limits to the number of specific patients who may be cared for must be identified.
Locum tenens privileges may be granted for specific periods of time. These periods do not have to sequential.

Question 4

DNV NIAHO for Hospitals
Temporary Privileges/Provisional Credentialing

Answer 4

MS 7
When dictated by urgent patient care need or when an application is complete without any negative or adverse information before action by the medical staff or governing body, the chief executive officer or designee may grant temporary clinical privileges:
SR.1 On the recommendation of a member of the medical executive committee, president of the medical staff, or medical director (as defined by t he medical staff); SR.2 for a period of time not to exceed 120 days
SR.3 Criteria for granting temporary privileges
- SR.3a Primary verification of education (AMA/AOA Profile is acceptable);
- SR.3b demonstration of current competence,
- SR.3.c Primary verification of state professional licenses
- SR.3d receipt of professional references (including current competence); and
SR.3e Receipt of database profiles from AMA, AOA, NPDB, and OIG Medicare/Medicaid Exclusions.

Question 5

URAC Health Plan
Temporary Privileges/Provisional Credentialing

Answer 5

The organization can grant ‘provisional’ participation status for a limited time when justified by continuity or quality of care issues on approval of the senior clinical staff person. The organization should complete the credentialing process as quickly as possible for providers with provisional status.

Question 6

Medicare Hospital CoPs and Interp Guidelines
Temporary Privileges/Provisional Credentialing

Answer 6

Not Specifically addressed

Question 6

AAAHC For Ambulatory Health Care
Temporary Privileges/Provisional Credentialing

Answer 6

Not specifically addressed