Centralized Credentialing – Frequently Asked Questions (FAQs) for New Providers

What is a CVO?

Why is RWJBarnabas Health (RWJBH) developing a Credentials Verification Organization (CVO)?

RWJBH aims to eliminate redundancy and duplication of efforts relating to provider credentialing functions of the various RWJBH hospitals and organizations.

What are the benefits of the CVO?

• The CVO provides a single point of contact for the physicians or other health care practitioners to expedite the gathering of credentialing information with a simplified process and minimal disruption for their support staff.
• The benefit to the provider at the time of initial appointment or reappointment is the submission of one universal application and one set of documents to apply for medical staff membership and/or clinical privileges at as many RWJBH hospitals as desired.
• For providers requiring insurance credentialing, the RWJBH universal application will also facilitate the credentialing associated with payor enrollment.
• The CVO will serve as a central repository for providers allowing for one point of contact where providers may submit documents and update contact information. The CVO will then provide notification of changes to downstream systems/departments.

Why is credentialing by the CVO required?

Similar to other health care organizations, RWJBH is legally responsible for knowing that individuals providing patient care are qualified and competent to do so. The Joint Commission, DNV, The Centers for Medicare and Medicaid Services (CMS), National Committee on Quality Assurance (NCQA), the New Jersey Department of Health and other oversight organizations require that members of the medical and advanced practice staff be credentialed and privileged before working in the hospital.

Does this mean there is one Medical Staff for RWJBH?

No. A CVO does not replace the roles/responsibilities of the local Medical Staff Offices. The CVO performs credentialing responsibilities in support of the local hospitals. Each local hospital will maintain a separate Medical Staff.

I recently accepted employment with an RWJBH entity and I am applying for credentials/privileges through the CVO. Will the CVO be able to answer questions as it pertains to my employment with the health system?

• No. While the CVO partners with HR to ensure that credentialing activities align with employment onboarding activities, we exist as a separate function from Human Resources.
• Medical staff membership and clinical privileges are often contingent upon continued employment with RWJBH. In many instances, membership and privileges are coterminous with employment.
• Questions as they pertain to your contract, benefits and on-boarding should be directed to Physician Contracting and/or your HR Talent Acquisition specialist.

Credentialing/Privileging

What is Credentialing?

Credentialing is the primary source verification of a health care practitioner's education, training, work experience, license, etc. This process ensures health care practitioners are who they claim to be, and ensure they have the proper qualifications and experience to care for patients.

What is Clinical Privileging?

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. Each specialty has specific criteria that must be met prior to granting the privilege.

Who will make decisions regarding the granting of medical staff membership and/or clinical privileges at the local hospital where I may apply?

Decisions regarding medical staff membership and the granting of clinical privileges will be made by the local hospital in accordance with their designated Medical Staff bylaws; rules, and regulations; and associated policies and procedures.

Will physicians or other practitioners be granted the same privileges at each hospital?

Wherever possible, the CVO is working to establish standardized privilege sets for clinical specialties. However, privileges will be granted based on:

1. the availability of services at a local hospital and
2. hospital specific criteria for granting of privileges.

Initial Application

How does a physician or other health care practitioner initiate the credentialing process and/or apply for clinical privileges?

For information see Application for Privileges.

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

Most health care organizations advise applying 90 days before a practitioner's start date. Ninety days is a benchmark because it allows extra time when verification sources do not respond in a timely manner or clarification of discrepancies is required.

Is there anything a practitioner can do to expedite the credentialing process?

Yes. Practitioners can greatly influence the length of processing time by contacting their verification sources and asking each source to respond to RWJBH's verification requests as soon as possible.

If I am already on staff at an RWJBH hospital, how do I apply to another RWJBH entity?

See Application for Privileges.

If I am already on staff at an RWJBH hospital, how do I request changes to my current listing of privileges at a local hospital (additions/relinquishments)?

Please contact the appropriate RWJBH hospital’s Medical Staff Office for which you wish to request additional privileges.

Will applicants incur any fees associated with applying to RWJBH through the CVO?

An initial application CVO processing fee of $900 will be charged to the initial applicants. There is no CVO fee for the subsequent processing of a re-credentialing application. In addition to the CVO application fee, most local hospitals charge annual medical staff dues. Rates vary depending on the local hospital policies, procedures and bylaws. For additional information, contact the individual medical staff office representatives.

Required Documentation

What information must I supply in support of my credentialing application?

The following documentation should be submitted in support of your credentialing application. The individual elements required will vary based on your specialty designation. To confirm requirements based on individual hospital please consult the respective hospital’s medical staff bylaws and/or credentials policy.

• Educational Diplomas/Certificates
• Board Certification
• NJ State Licensure
  • To apply for a NJ License, access the Consumer Affairs website.
• NJ CDS Licensure
  • To apply for a NJ CDS License, access the Drug Control Unit.
• DEA Registration
  • To apply for a DEA Registration Certificate, access the U.S. Department of Justice, Diversion Control Division.
  • Make changes to an existing DEA Registration Certificate.
• Professional Liability Insurance Certificate
  • For applicants who are on-boarding related to employment with RWJBH or Rutgers Robert Wood Johnson Medical School the liability insurance certificates will be supplied directly to the CVO on your behalf.
• Life Support Certification as issued by the American Heart Association
• Procedure Logs detailing clinical activities performed over the prior 12-24 months
• Documentation of continuing education required to support clinical privilege requests