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Frequently Asked Questions about Credentialing and Privileging

General Questions

What is credentialing?

Credentialing is a term that usually encompasses two separate processes: credentialing and privileging. Credentialing is the primary source verification of a health care practitioner’s education, training, work experience, license, etc. Privileging is granting approval for an individual to perform a specific procedure or specific set of privileges based on documented competence in the specialty in which privileges are requested.

Who is credentialed?

The Kaleida Health Central Verification Office must credential each individual working in the hospital or clinic setting who is independently responsible for patient care by virtue of their license and hospital authority. Licensed independent practitioners who must be credentialed are physicians, dentists, certified nurse midwives, podiatrists, nurse practitioners, physician assistants, certified registered nurse anesthetists and psychologists.

Why does Kaleida Health credential?

Kaleida Health, like other healthcare organizations, is legally responsible for knowing that individuals providing patient care are qualified and competent to do so. Det Norske Veritas (DNV), The Centers for Medicare and Medicaid Services (CMS), National Committee on Quality Assurance (NCQA), the New York State Department of Health and other oversight organizations require that members of the medical and allied health staff be credentialed and privileged before working in the facility.

Can a physician or other practitioner work before completing the credentialing process?

No.  The only exception is that any medical student, resident or fellow who is in a training program affiliated with Kaleida Health can work in the facility without being credentialed as long as their practice does not fall outside the scope of their current training program.

How do I know if I am currently credentialed with Kaleida Health?

You can contact the Kaleida Health Central Verification Office at (716) 859-5501. One of the credentialing specialists can advise you of where your application is in the approval process.

How does a practitioner get credentialed and request privileges at Kaleida Health?

Please access the online Application for Privileges or submit a written request for an application to the Kaleida Health Central Verification Office by email or fax. Please include:

  • Full legal name
  • NPI number
  • Preferred email address

Email: RWecker@kaleidahealth.org
Fax: (716) 859-5593

How does a practitioner update their profile information such as submitting a name change or office address change?

Contact the Central Verification Office and submit the information to be corrected by e-mail or fax. Please be sure to sign and date the change request.

Email: RWecker@kaleidahealth.org
Fax: (716) 859-5593

How long will it take to obtain my license?

This question can only be answered with an educated estimate, since the time can vary by profession and the State Medical Board.  A rough time line for New York State licensing is 3 to 6 months for domestic graduates and 2 to 8 months for international graduates. 

Initial Application Questions

How far in advance of my start date should I begin the credentialing process?

We recommend, if possible, that practitioners submit her/his application six (6) months before her/his anticipated start date, and minimally, three (3) month in advance. This will allow extra time when verification sources do not respond in a timely manner or clarification of discrepancies is required.  Please note that a practitioner must have privileges before she/he can be credentialed with the insurers and obtain a billing number. For those practitioners providing services that Kaleida Health will bill for, Kaleida Health needs three months for new residency graduates and up to one month for other providers after the provider has her/his privileges to obtain billing numbers..

Is there anything a practitioner can do to speed up the application process?

Yes. Practitioners can greatly influence the length of processing time by contacting their verification sources and asking each source to mail or fax Kaleida Health’s verification requests back as soon as possible. Practitioners can also assist by submitting all of the documents outlined on the checklist on the front of the application.

What are the top three things that hold up the initial appointment process?

Failure to submit all of the documentation needed with the application. The complete listing of documents/submissions is found on the checklist on the front of the application.

  • Incomplete information. Please provide complete information – names, addresses, phone numbers, fax numbers and e-mail addresses for past affiliations/current affiliations/education is needed. 
  • Peer references. Please contact your references and advise them that correspondence will be coming from Kaleida Health and impress upon them the importance of a timely response. A current e-mail and/or fax number for your references is helpful in decreasing the turn around time to get a response from your references.

How do I submit a credentialing application?

Submit a completed credentialing application to the following address:

Kaleida Health
Central Verification Office
1028 Main Street, 3rd Floor
Buffalo, New York 14202


What are the steps in the credentialing process?

The credentialing process can take up to 6 weeks to complete once your applications is ready for review, because the various medical staff committees that are involved in the credentialing process only meet once each month. The parties that must review completed applications are: applicable Chief of Service; Health Professional Affiliates Committee (for all Allied Health Professional members); Credentials Chairperson; Medical Executive Committee and subcommittee of the Board of Directors.  The steps in the credentialing process are:

  • Practitioner submits complete application for medical staff membership and privileges.
  • Medical Staff Office performs primary source verification on practitioner’s credentials, education and training.
  • Practitioner interviews with Chief of Service.
  • Medical Staff Office completes primary source verification and places file in Chief of Service drawer.
  • Chief of Service completes file review and recommendation and signs off on privileges.
  • Allied Health Professionals Committee completes file review and recommendation (for all Allied Health Professional practitioners only).
  • Credentials Chairperson completes file review and recommends file for approval to Credentials Committee (meets 1st Wednesday of each month).
  • File is presented to Medical Executive Committee (meets 3rd Wednesday of each month) for review and recommendation to Board of Directors.
  • File is presented to subcommittee of Board of Directors (meets 1st Wednesday of each month) for review and final sign off.

Does Kaleida Health have temporary privileges?

The Kaleida Health Medical and Dental Staff does not have temporary privileges. However, for an applicant whose primary source verification is complete and no negative or adverse information was identified during the credentialing process, before action is taken by the Board of Directors on a file, the applicant’s Chief of Service can request a limited privilege for a provider. This limited privelage cannot exceed 30 days. The Chief of Service submits a request in writing to the Medical Staff Office, who then submits the request to the Executive Vice President and Chief Medical Officer and Medical Staff President for review and approval. 

Reappointment Questions

What is reappointment?

Reappointment is the process of re-evaluating a practitioner’s current competency after they have been appointed to the medical staff or professional staff.

Once I am on staff, why do I need to go through the paperwork again?

Det Norske Veritas (DNV) hospital accreditation standards require all practitioners to complete a reappointment process every 24 months.  Kaleida Health has a duty to ensure that all practitioners on staff are currently competent, and reappointment is the process of re-evaluating competency.

What happens if I do not complete my reappointment paperwork?

If a practitioner does not complete reappointment paperwork on time, the practitioner’s reappointment will expire and they can no longer work or see patients in a Kaleida Health facility.

Expirables Questions

What are expirables?

Expirables include a practitioner's:

  • License to practice
  • Malpractice insurance
  • DEA certificate
  • Board certification
  • Health status and PPD

The Kaleida Health Medical and Dental Staff Bylaws require practitioners to maintain current expirables at all times. Failure to renew license or insurance will result in suspension of medical staff privileges at Kaleida Health until renewal is verified by the Kaleida Central Verification Office. A practitioner must update her/his health status and PPD on an annual basis.  Please contact the Central Verification Office at 859-5501 or 859-5509 to obtain a current health assessment and PPD documentation form.

The Kaleida Central Verification Office staff monitors expiration dates and request renewals from practitioners prior to expiration. All practitioners on staff at Kaleida Health must provide the Kaleida Central Verification Office with renewed credentials or certificates PRIOR to expiration.

License

  • Renewals must be primary source verified directly with the licensing board by the Kaleida Central Verification Office
  • Practitioners will be notified one month prior to the expiration of the above items and advised to update/renew them.
  • Licensing boards are contacted to determine which licenses have been renewed.
  • Reminders are sent to practitioners who have not renewed their license.
  • The day after expiration Kaleida Health sends notification to each site Chief Medical Officer, surgical schedulers, appropriate Chief of Service and Supervising/Collaborating Physician (if applicable) of those practitioners who have not renewed their license.  Privileges are suspended and practitioners cannot work at Kaleida Health until the Kaleida Central Verification Office verifies renewal.

DEA Certificate

  • DEA registration website is accessed to determine what DEA registrations have been renewed.
  • Practitioners will be notified one month prior to the expiration of the above items and advised to update/renew them.

Malpractice Insurance

  • Copy of renewed malpractice insurance certificate must be received by the Kaleida Health Central Verification Office prior to expiration.
  • Practitioners will be notified one month prior to the expiration of the above items and advised to update/renew them.
  • The day after expiration Kaleida Health sends notification to each site Chief Medical Officer, surgical schedulers, appropriate Chief of Service and Supervising/Collaborating Physician (if applicable) of those practitioners who have not renewed their license.  Privileges are suspended and practitioners cannot work at Kaleida Health until the Kaleida Central Verification Office verifies renewal.

Board Certification

  • Renewals must be primary source verified directly with the certifying board by the Centralized Credentialing Department.
  • Practitioners will be notified one month prior to the expiration of the above items and advised to update/renew them.

Health Assessment and/or PPD

  • Kaleida Health Medical and Dental Staff will not accept a health assessment where the practitioner signs and attests to her/his own current medical competency.
  • Practitioners will be notified one month prior to the expiration of the health assessment and/or PPD and advised to update the Central Verification Office by having her/his health care provider complete a new Health Assessment form. 
  • The day after expiration Kaleida Health sends notification to each site Chief Medical Officer, surgical schedulers, appropriate Chief of Service and Supervising/Collaborating Physician (if applicable) of those practitioners whose health assessment and/or PPD has expired.  Privileges are suspended and practitioners cannot work at Kaleida Health until the Kaleida Central Verification Office obtains a current health assessment and/or PPD for the provider.