The NCQA is a governing body that sets out credentialing rules and regulations for Plans and CVO's. The NCQA is also the body that we and many of our partners follow. The NCQA requires us to check for a practitioner's last five years of relevant work history and gather explanations for gaps greater than six months. In situations where the practitioner does not have five years of work history, we are required to check work history from original licensure issue date. Additionally, the provider must attest to what their license issue date is.
If the provider does not have the required work history the NCQA only allows a fellowship to be used as evidence of work history. We are not allowed to use any Internships or Residency in the same way.
In order to move forward we would need the provider to provide a written explanation stating what they have been doing since their initial license issue date, even if it to explain that they are/were taking part of a residency or internship program. We can take an updated credentialing application, a CV that shows evidence of work history or a written note (forwarded email, letter, etc) from the provider.
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