CurrentBaylor Scott & White Health PlanPolicy SWHP PNO.012.P

Credentials Committee's Roles and Responsibilities

Governs the authority, composition, meeting cadence, and responsibilities of the SWHPI/ICSW Credentials Committee for all lines of business at Scott and White Health Plan and who it affects (the Board, committee members, credentialing delegates, and practitioners/providers serving members).

Policy Summary

PayerBaylor Scott & White Health Plan

PolicyCredentials Committee's Roles and Responsibilities

Policy CodePolicy SWHP PNO.012.P

Change TypeNo material change

Effective DateApr 14, 2021

Next Review Date

Key ActionBoard delegates peer review and credentialing activities to the SWHPI/ICSW Credentials Committee; the committee approves delegation and delegates primary source verification and administrative file functions to the credentialing delegates' office.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

All Lines of BusinessApplies to

MonthlyMeeting frequency

1CMO serves as Chair

DelegatedDelegation status

Credentials Committee Responsibilities

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Credentialing governance and committee responsibilities

Responsibilities and scope of review for credentialing governance and the Credentials Committee.

The Board of Directors is the governing body for SWHPI/ICSW and provides delineation of responsibility for entities involved in review and approval of policies, procedures, and practitioner/provider applications.

The Board delegates the peer review function and credentialing activities to the SWHPI/ICSW Credentials Committee.

The Credentials Committee includes representation from a range of participating practitioners, including behavioral health.

The SWHPI/ICSW Chief Medical Officer serves as Chair (or may designate the Medical Director designee) and is the physician directly responsible for the credentialing program; Chair or designee is responsible for review of clean files, if available.

The Credentials Committee meets monthly.

The Credentials Committee approves credentialing delegation and provides oversight of credentialing and re-credentialing activities, including delegated functions.

The Committee delegates primary source verification and administrative file functions to the credentialing delegates' office.

The Committee reviews and approves Credentialing Policies and Procedures, including performance criteria, and reviews credentialing and re-credentialing data for practitioners/providers rendering care to SWHPI/ICSW members.

The Committee reviews files of practitioners/providers who fail to meet performance criteria and functions as the peer review body for non-contracted practitioners/providers providing services to SWHPI/ICSW members.

Delegation and Approval

Prior Authorization

Board delegates credentialing and peer review; Committee approves delegations

The Board of Directors formally delegates peer review and credentialing activities to the SWHPI/ICSW Credentials Committee; the committee is responsible for approving any credentialing delegations and for oversight of credentialing and re‑credentialing activities, including those delegated to credentialing delegates' offices.

Board delegates the peer review function to SWHPI/ICSW Credentials Committee.
Board delegates credentialing activities to SWHPI/ICSW Credentials Committee.
Credentials Committee approves credentialing delegation and provides oversight of credentialing/re‑credentialing activities, including those delegated.
Committee delegates primary source verification and administrative file function to the credentialing delegates' office.

Defined Terms

Defined terms

Custom defined terms in this policyNone — this document states no custom defined terms; refer to the BSWH P&P Definitions document for defined terms.

Where to find definitionsSee the BSWH P&P Definitions document for additional defined terms.

Capitalization noteWhen used with initial capital letter(s), words/phrases have the meanings set forth in this document or in the BSWH P&P Definitions document.