§1703F Credentialing Verification Requirements for Providers of Non-department Health Care Services

Summary

The Secretary must make sure third-party administrators and credentialing organizations follow rules to keep certain outside health providers from giving care to veterans. Those groups must have active national accreditation, check a provider’s work history and license sanctions in every State and territory going back at least 10 years and including the time before they first provided outside care, re-check credentials at least every three years, continuously monitor providers using the National Practitioner Data Bank, and do any other checks the Secretary requires. Definitions: “credentials verification organization” — the group that handles credential checks for outside providers in the Veterans Community Care Program. “Third Party Administrator” — the group that runs a provider network and related admin services for that program. “Veterans Care Agreement” — the contract for outside care. “Non-Department health care services” — care at non-VA facilities or care bought through the Choice or Medical Community Care programs.