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Credentialing

This process was developed in response to the JCAHO’s new standard, effective 1/1/01, regarding credentialing and privileging of physicians by organizations which will receive the provider’s service (the remote site where the patient is physically located). The standard reads:

If a telemedicine practitioner prescribes, renders a diagnosis, or otherwise provides clinical treatment to a patient, the telemedicine practitioner is credentialed and privileged through the medical staff mechanisms set forth in MS.5 through MS.5.15.7 by the organization receiving the telemedicine service. An organization may use credentialing information from another Joint Commission accredited facility, so long as the decision to delineate privileges is made at the facility that is receiving the telemedicine service. Consideration of appropriate utilization of telemedicine equipment by the telemedicine practitioner is encompassed in clinical privileging decisions. See the Environment of Care chapter standards EC1.6; EC1.7; and EC2.8.

The following steps are to be taken in the event a UMHS physician is providing health care services to a patient via telemedicine:

1. A UMHS physician agrees to see a patient via telemedicine and an appointment is scheduled.
2. The UMHS provider of the telemedicine service signs the authorization for release of credentialing and privileging information.* The authorization is in effect until the contract for service delivery expires or the physician’s credentialing anniversary date, whichever is shorter.
3. A Telemedicine Resource Center (TRC) or Maternal and Child Health (MCHC) Telemedicine Project staff person will take the signed form to the Medical Staff Office and leaves a copy with them.
4. The telemedicine staff person will photocopy the physician’s Credentialing Profile and list of privileges and fax to the receiving facility.
5. UMHS will request a letter from the receiving facility acknowledging their acceptance of the credentials and privileges sent to them.
6. All materials related to this process will be centrally filed in the TRC.

* If the provider has previously signed this form this step will be omitted and the information will be released.

UMHHC Policy For Physician Credentialing and Privileging Information for Delivery/Receipt of Telemedicine Services
(Accessible to UMHS faculty and staff only)

Marquette General Hospital Credentialing Request Form

CLICK HERE to download

(Word 97-2003 & 6.0/95 - RTF, 8 KB)

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