Credentialing

Provider Credentialing Process

Our credentialing office supports new and existing providers with obtaining, renewing, and maintaining their medical staff membership and their privileges.

We contract with Lake Superior Credentialing Verification Service and collaborate to collect and process applications for initial appointment, reappointment and additional privileges. This includes:

• Obtaining primary source verification (verifying all data on the application directly with the data source — medical school, residency program, previous hospitals, or licensing board, etc.)
• Identifying and investigating red flags on the credentialing application
• Conduct ongoing verification of licensure, malpractice insurance, DEA registration, and board certification for all applicable practitioners.
• Conduct ongoing monitoring of Medicare/Medicaid sanctions and of any disciplinary actions (including actions taken on licensure, DEA registration, hospital privileges, etc.)
• Track Focused Professional Practice Evaluation (FPPE) and Ongoing Professional Practice Evaluation (OPPE) completion
• Ensure medical staff compliance with Joint Commission credentialing standards; prepare for and participate in hospital accreditation and regulatory surveys.
• Maintain privilege forms
• Maintain credentials records
• Verify RHCC medical staff membership and privileges for other organizations
• Complete insurance payor credentialing process for medical staff

Mailing Address:
Credentialing Department
Riverwood Healthcare Center
200 Bunker Hill Drive
Aitkin, MN 56431