Medical Staff: Credentialing and Privileging
Thank you for your interest in Ridgeview. Below is an overview of the credentialing, privileging, enrolling with payers, and onboarding process at Ridgeview that must be completed prior to providing care and services to patients.
To request an application please complete the Application Request Form.
Once the request has been processed, you will receive two emails from Ridgeview containing User Name and Password to log in to the Portal to complete and submit the application.
As part of the application process, you will attest to having read the following materials:
- Medical Staff Bylaws and Supporting Documents:
- Medical Staff Conduct Policy [PDF]
- Standards for Pain Management [PDF]
- Restraint Education Document [PDF]
- Code of Ethical Behavior and Business [PDF]
Additional forms/information you may need to read and complete
Change in personal information/Name change or resignation requests
If you have any questions or would like to change your personal information on file, contact the Medical Staff Office at firstname.lastname@example.org.
In all cases, the length of time required to complete the credentialing processes is influenced by how timely Ridgeview receives complete and verified information.
If you are an employee of Ridgeview, we make every effort to use the information collected during your hiring process. However, we may ask for updated or additional information.
Again, thank you for considering Ridgeview.
Most frequent delays can include:
- missing attachments
- missing date such as email addresses for references
- no license
- Unexplained discrepancies or gaps in employment
- malpractice case data not provided
- references that do not reply
- name changes—need to always match license
Verification schedule for initial applications
It is helpful to understand what happens once a file is sent to the Medical Staff Office for processing. All elements of an applicant's background are verified.
Your help is appreciated, however, the only help that can be accepted are prompts to external facilities to send the needed data. Code requires all documents to be requested by and returned to Ridgeview; this is called Primary Source Verification (PSV). This ensures confidentiality and prevents falsification of documents. The help you provide when we ask for documents or new names for references is appreciated.
Elements that must be verified:
- Medical school, internship, residency and fellowship
- License, DEA, Board Certifications, malpractice insurance
- Past and present jobs (including moonlighting) and hospital affiliations
- References - must be colleagues that can attest to the applicant's clinical competency that have worked with the applicant in the past 12 months and have the same degree or higher
- Office of Inspector General
- ECFMG (if applicable)
- Background check
- Medicare Opt Out
- National Practitioner Databank
- Gaps in employment or education over 90 days
- Any other items requested by the Credentials Committee after review (such as additional references or a background check, etc.)
All items provided with the application are reviewed to ensure they match the above verifications. For example the AMA profile is compared to the application data. This may help fill in gaps or may lead to requesting explanations of discrepancies.
Missing items cause delays to occur as the verifications cannot be completed.
For complete applications, the following will take place:
Letters are emailed and the verifications that take the longest are requested; these are missing elements requests, work affiliations (current and past work facilities), and references.
The applicant's signatures are good for 120 days. Most files are complete within this time frame but if not, second signatures are required. The signatures are releases and attestations that the information submitted is true and accurate.
- 90 to 120 days to process verifications and request missing elements
- 30 days for chair evaluation
- 30 days for review by Credentials Committee, Medical Executive Committee and the Board
Most frequent reasons for delays:
- Incomplete applications (not all questions answered)
- Missing attachments
- Missing data such as email addresses for references
- No license
- Discrepancies or gaps in employment not explained
- Malpractice case data not provided
- References that do not reply
- Names changes – need to match license always
Provider Enrollment is responsible for enrollment, re-credentialing, terminations of any practitioner who bills professional services at Ridgeview with the third-party commercial and government payers/health plans. By completing this process, it ensures the practitioner is enrolled with Medicare, Medicaid and applicable third-party payers so that Ridgeview can bill and be reimbursed for care, treatment or services provided at a Ridgeview facility. Please note that the rules and systems used to complete provider enrollment varies across health plans. If applicable, you would receive information from the Ridgeview Provider Enrollment Team that would begin the process to set you up as a billing provider with Medicare, Medicaid and third-party payers. Provider Enrollment can be reached at email@example.com.
Requirements for clinical credentialing, privileging and provider enrollment processes are driven by regulation and accrediting body standards, including, but not limited to:
- Det Norske Veritas (DNV)
- Centers for Medicare and Medicaid Services (CMS)
- Medical Staff Bylaws
- Ridgeview policies and procedures
Again, thank you for considering Ridgeview.