The credentialing process has two distinct elements, each very important. The NCQA certification process is a voluntary review process that includes rigorous on-site evaluations conducted by a team of healthcare professionals and certified credentials specialists. The NCQA evaluates data collection and verification operations, audits completed files, reviews policies and procedures, evaluates mechanisms to ensure data integrity and confidentiality, and monitors the process used to continuously improve the services the CVO provides. After the on-site review, a national oversight committee analyzes the team’s findings and determines certification based on the CVO’s compliance with NCQA standards. Managed Care organizations must to adhere to this process.

Credentialing is an important process that all Medical Centers are required to complete. Credentialing and re-credentialing processes are designed for accuracy, uniformity and consistency of information. It is critical to maintain compliance with the NCQA standards. Our entire process can be tailored to meet NCQA & URAC standards (we can also meet JCAHO standards if required). InterMedCorp staff prepares all materials, schedules the visits and works with the provider offices to minimize any disruption to patient care activities.

We use Data Collection Tools (DCTs) that are designed after the NHP Data Collection Survey Tools that NCQA designed for managed care organizations to prepare for an NCQA accreditation survey. Our DCTs provide a simple, complete and optimized survey in a format standardized for organization and scoring in compliance with NCQA Standards. Since JACHO no longer requires site visits, our tool is more focused on NCQA requirements resulting in an abbreviated DCT. This concise tool results in less interruption to provider offices and faster results for our customers. Scoring is completed on site and a copy of the completed survey can be made available immediately for anyone (provider, health plan, etc.) desired. We can even offer a digital image of the completed survey for audit purposes. If however, it would it is desired that we use a tool that is currently being deployed, we would be happy to used one that is supplied.

Our tool is also comprised for the practicing physician in mind. Our tool is limited to no more than 30 questions with an additional 10 if the state mandates. Questions center around physical attributes, check in process, policies and procedures and documentation practices (medical record keeping). The tool is designed to be easily understood and completed within a timeframe of 20-30 minutes.

Providers tend to respond to the initial call for a site visit with a degree of inconvenience and tension, however, the amount of time and disruption caused by these visits can be eased by using a tool that gets right to essential needs for scoring. It is very important to ensure that the office information is collected accurately and professionally. To this end, InterMedCorp uses a national network of medical professionals, trained at collection and evaluation.

Objectives

The insurance industry has been hit hard with changes over the last several years with new legislation and regulations physicians and carriers are scrambling to stay up to date and informed in an effort to stay in compliance and run efficiently. The cost of competing in the insurance markets is increasing, the variety of plans carriers are being asked to offer is increasing and HIPAA has forced compliance with costly updates to systems and personnel training. Outsourcing is a wise decision when the labor-intensive tasks of site visit reviews are performed by a reliable company like InterMedCorp.

InterMedCorp uses the following objectives that allow us to succeed more effectively than our competition:

• Our upper management staff is stable. The same directors will complete your relationship from start and continue over the life of the relationship.
• InterMedCorp offers high standards for quality; we do not assess the success of a relationship on the margin we gain but rather the satisfaction of our clients.
• Faster can be better. InterMedCorp has done this before and have been able to trim time without sacrificing quality.
• We have built a secure socket layer and secure logon, which allow tracking and query to allow our clients constant status of work in process.
• We have a national team of nurses and medical reviewers to service our clients.

A Bias for Quality

Reviewers understand that the primary purpose of medical offices is to provide patient care, not accommodate site visits. InterMedCorps process is designed to make this experience less intrusive and professional for all. Following you find the list of our guiding principles in the review process:

• Schedule appointment promptly
• Arrived as scheduled.
• Always be professional and courteous.
• Complete the survey with minimal disruption to the office.
• Be knowledgeable of the review process and able to answer questions. Complete results in an expedited fashion.