W. Va. Code R. § 64-89B-4

Current through Register Vol. XLI, No. 36, September 6, 2024

Section 64-89B-4 - Duties and Timelines of the Credentialing Verification Organization

4.1. The CVO shall be responsible for accepting and processing all credentialing applications required of health care practitioners, including verification of all credentialing information by generally accepted procedures endorsed and certified by NCQA, the Joint Commission and other relevant regulatory agencies.

4.1.a. All verifications shall be electronically recorded in order to document the specific verification query, request attempt type, date and number and response information.

4.1.b. When primary source verification is not obtainable due to circumstances outside the CVO's control, such as facility closures or missing and inaccessible records, this will be noted in the practitioner's electronic and paper file and will appear on the CVO's verification printout.

4.1.c. Initial verification profiles of new credentialing applicants shall be completed by CVO within 30 days after its receipt of a completed and clean credentialing application form. The CVO shall have procedures in place to provide expedited processing of initial applications upon request by the practitioner or credentialing entity.

4.1.d. After a practitioner's initial credentialing application has been completed and verified, subsequent requests for completed verifications profiles shall be delivered to requesting credentialing entity, with prior release and authorization, within 15 days of request, with allowances for emergency expedited requests.

4.2. Upon receipt of a completed recredentialing application form, the CVO shall provide a verification profile within 30 days, with provisions for an expedited process upon request.

4.3. It is the responsibility of every credentialing entity contracting with the CVO to obtain authorizations signed by the practitioner seeking to be credentialed and to furnish such forms to the CVO.

W. Va. Code R. § 64-89B-4