Credentialing files in Medallion were updated for greater accuracy and ease of use, making adherence to NCQA, CMS, and payer requirements even more accessible. Both on-platform and PDF files have changed in the following notable ways:
A newly updated summary page highlighting the following information:
Whether the file is for an initial credentialing or a recredentialing.
The date on which the application was completed.
Whether the file is clean, incomplete, or has an issue.
The name of the organization the credentialing file is for.
This page improves compliance, makes it easier to access the most important information, and makes the files more accessible for auditors.
The following four sections, each with its own verification status, rather than a single Provider Application covering all four:
Provider Application
Work History
Malpractice Insurance
Disclosure Questions
This change makes it easier to determine which sections of application validations are passing and which are failing, in order to maintain industry standards and keep up with NCQA guidelines.
The following clarifications in credentialing files' language and terminology:
Automated PSVs now include data on how and when verification evidence was sourced from the primary source, using Source by and Source on.
All PSVs now include which specialist reviewed and verified the evidence that was pulled, using Verified by and Verified on.
PSV statuses have been consolidated into only three: Clean, Issue, and Incomplete.
Credentialing files now have greater clarity about proxy verifications. When education is verified by proxy, that is indicated in the credentialing file. This makes the files easier to use and understand.
CAQH Universal and state applications are automatically appended to credentialing files when applicable, in order to keep up with compliance requirements.
PSVs have been updated to include only one section, Verification Information, highlighting evidence from primary sources and criteria used to find matching PSVs. This makes the files easier to use and understand and increases accessibility for auditors.
Evidence documents over one page long are now supported, in order to keep up with compliance requirements.