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Credentialing

NCQA defines credentialing as “[a] process by which an organization reviews and evaluates qualifications of licensed independent practitioners to provide services to its members.”

Why do you need credentialing?
  • Patient Safety
  • Risk Management Concerns
  • Requirements of Accrediting and Regulatory Agencies

APHCA's Credentialing Verification Organization (CVO)’s mission is to provide superior service in verifications and ongoing credentialing monitoring to allow members to do the review and evaluations with thoroughly reviewed information on their practitioners.  This relieves members from the tedious credentialing process and allows them to tap into APHCA staff’s combined 28 years of experience in the field.  APHCA offers initial credentialing, ongoing monitoring, changes in credentialing and recredentialing.  Practitioners are required to complete the recredentialing process every two years from the date of their initial credentialing.  

The CVO considers all accreditation standards required to meet credentialing, including:
  • CoPs – Medicare Conditions of Participation
  • NCQA – National Committee for Quality Assurance
  • HRSA – Health Resources & Services Administration
  • JC – The Joint Commission
  • FTCA – Federal Tort Claims Act
  • Applicable Alabama State Regulations
  • Applicable Federal Regulations


Our CVO’s Credentialing Process includes verification:
  • Licensure, registration, or certification
  • Education and/or training
  • Current competence
  • Health fitness
  • Government issued picture identification
  • TB/PPD
  • Life support training
  • Drug Enforcement Administration (DEA) registration
  • National Practitioner Databank (NPDB), if licensed
  • Malpractice claims history
  • Medicare/Medicaid Sanctions

The CVO strives to dot all the “I’s” and cross all of the “T’s.”  APHCA follows up on any inconsitent information or red flags.  We anticipate what you would want to know and we go get the answers. 

For pricing and to schedule a consultation, please message credentialing@alphca.com