The Credentialing service at Sun Knowledge stands out as the process of formal recognition and attestation of an individual’s current medical, professional or technical competence and performance. It evaluates and monitors a practitioner’s decision-making, pertaining to clinical or medical reviews. This process ensures that he stringently complies with the applicable professional standards for direct medical care and/or peer reviews. Credentialing, in other words, investigates, observes and verifies everything associated with a practitioner’s professional life, including his license, experience, certification, education, training, malpractices, adverse clinical occurrences, clinical judgments, technical capabilities, and character. It defines his scope of practice as well as clinical or review services, he may deliver, guarantying that his activities are well within the limits of privileges, conferred upon him
This process, a product of an objective practitioner-controlled peer review, utilizes criteria that have been established through common legal, professional and administrative practices. These criteria must be directly related to the quality of patient care and documented practitioner performance should be measured against these criteria. The entire Credentialing process must be thoroughly consistent and peer review decisions must be fair, reasonable, disciplined, logical and performed in good faith. These decisions must also be justifiable, unbiased and have ‘dated’ detailed documentation. Credentialing decisions should be kept confidential, away from the prying eyes. In cases of adverse peer review decisions, avenues of appeals, utilizing due process and the inclusion of fair hearings, must be made available to the credentialed practitioner.
Sun Knowledge’s Credentialing services define the intent and scope of client requirements, demonstrating 100% compliance with the guidelines of Medicare Managed Care Manual (Provider Selection and Credentialing) as well as National Committee for Quality Assurance (NCQA).
