C
Definition
The formal process of verifying the qualifications, licensure, insurance, and background checks of a transportation provider, vehicle, and driver before they are allowed to perform services.
Overview
Why it Matters
Safety and Compliance. Payers must ensure that tax dollars are not going to unlicensed drivers or unsafe vehicles.
How it Works
Providers submit packets of documents (Drug tests, MVRs, vehicle inspections) to the Broker. The Broker validates them against databases (OIG exclusion list, DMV).
Code Comparison
Comparison: Credentialing vs. Contracting
Contracting is signing the business agreement (rates/terms). Credentialing is proving you are actually qualified to do the work. You need both.
Common Questions
- OIG List: Failing to check the Office of Inspector General exclusion list and hiring a driver banned from Medicaid (huge fines).
- Delay: Credentialing can take 30u201390 days. Hiring a driver and letting them drive before they are fully credentialed is a major compliance violation.
- Automate the renewal process. Use software that alerts you 60 days before a driveru2019s license or background check expires.
- Maintain digital "Driver Files" that are audit-ready at all times.
Sources
Joint Commission - Credentialing and Privileging