Overview
Providers may be contacted if their credentialing application is inaccessible or there is missing information to complete a verification.
We abide by all verification time limits for each specific primary source as per NCQA and other accrediting agencies, as applicable.
National Committee Quality Assurance Health Plan Standard:
The below is an excerpt from NCQA’s CR 4 Standard: Recredentialing Cycle Length:
The organization formally recredentials its practitioners at least every 36 months.
Element A: Recredentialing Cycle Length: The length of the recredentialing cycle is within the required 36-month time frame.
The 36-month recredentialing cycle begins on the date of the previous credentialing decision. NCQA counts the 36-month cycle to the month, not the day.
Provider Outreach Schedule:
Outreach is performed per the timeline below.
| Phase | Outreach Attempts | Return to Client | Cancelation | Deactivation |
| Timeline | 30 days following application review | Enters into this status once outreach attempts are completed but documentation is still missing |
Initials: 30 days after file moves to Returned to Client Recredentials: The 15th day of the month following the month of the recredential Due Date |
30 days after the checklists are canceled |
| Activity | 3 successful outreach attempts are made | Client is notified via the Outreach Report and advised to take action on providers who have had the“Return to Client” | We also cancel credentials that the client has not acted upon |
We deactivate the relationships for providers whose credential files have been canceled and have not had new checklists created and started. This also deactivates any providers who were up for recredentialing from the client’s NPDB account. |
Example Timeline for Initial Credentials:
- July 1 - Provider Submitted: The client submits an initial credential request to us on July 1. We review the provider’s credentialing application and determine it is noncompliant.
- July 1 - 31 - Outreach Attempts: We perform three successful outreach attempts within the month of July and continue to review the application for completeness and compliance; the application is still non-compliant.
- August 1 - August 31- Return to Client: In the first Outreach Report following three successful attempts and application reviews, the provider is assigned the status “Return to Client” in the Outreach Report. This signals that Client should review the provider’s application and either perform outreach of their own or cancel the credential event by deactivating the provider via the homepage. Note: if andros is If andros is unable to verify the verifications, the files will be returned to the client instead of being completed with an alert ‘unable to verify Board’.
- September 1 - September 30- Cancellation : 30 Days after the file has been in the “Return to Client” status the file will be moved to “cancellation” status.
October 1 - October 31- Deactivate Provider: We will deactivate provider relationship with entities such as NPDB 30 days after the cancellation date.
Watch the video below to learn more about Outreach.
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