Extra Credit Assignment Student: Sonia Uribe NCQA 180-day File Completion Rule NCQA sets time limits

for verifications; after all verifications have been completed for the physician, the file must be approved and all verifications must be within 180 days of the Credentialing Committees decision. The following verifications must be primary sourced verified within 180 days from the time of credentialing decision:

Board Certification; if a physician is not board certified then highest level of education; medical school or residency; fellowship training is not applicable Medical License Licensure Sanctions Malpractice History; NPDB/HIPDB can be used Liability History/Proof of Coverage Medicare and Medicaid; AMA, FEHB, FSMB, HIPDB, OIG, NPDB, or State Medicaid agency can be used as verification

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All verifications should be dated. Some exceptions to the 180 NCQA rule in reference to the time frame is that static credentialing does not chance for instance, graduation from medical school and medical training. There are only some excepted sources when it comes to verification of primary source; primary source is the source issuing the credential. NCQA standards require that the credentials verification information presented to the credentials committee be no older than 180 days. The date of the credentialing decision is what triggers the NCQA 180 day file completion rule having to run backwards to be applicable for all credentialing documents that need to be verified per NCQA within 180 days to meet the standard guideline.