Fairview System Credentialing Office

For Medical Professionals

The Fairview System Credentialing Office is compliant with The Joint Commission credentialing standards. We are also fully Certified by the National Committee for Quality Assurance (NCQA) for 10 out of 10 verification services, meeting NCQA's credentialing standards for health plans and managed care organizations.

Mission

Conduct a thorough review and verification of credentialing information so Fairview entities can evaluate practitioners' ability to provide quality patient care and minimize risk for Fairview Health Services.

Strive to provide Fairview entities with accurate information to facilitate their credentialing and privileging decisions.

Commit to upholding the standards of The Joint Commission and the National Committee for Quality Assurance, legal regulations, and the Fairview values of dignity, integrity, service and compassion.

Vision

The Fairview System Credentialing Office is used as a model for health care system Credentials Verification Organizations (CVO) and is recognized for customer-oriented service, community education and high quality credentialing directly impacting the quality patient care provided at Fairview entities.

About Us

The Fairview System Credentialing Office (FSCO) has implemented electronic processes for completing credentialing and privilege requests. Practitioners are notified of their reappointments via the email address on file with the FSCO, and no longer receive a paper packet in the mail. Please be sure to keep your email address up to date with the FSCO, and be sure to monitor your email for important credentialing information.

The Fairview System Credentialing Office is a Central Verification Office (CVO) that provides a wide range of services to its contracted entities. A CVO provides the following benefits:

  • Simplify the credentialing process — health care practitioners submit only one credentialing application and privilege form when applying to one or multiple Fairview contracted entities at initial appointment or reappointment.
  • Eliminate duplication of credentialing application and verification processes previously performed by each individual contracted entity.
  • Standardize the credentialing process and privilege forms throughout the Fairview System.
  • Efficiently store and manage practitioner credentialing information for all contracted entities in one centralized department and database.

Contracted Entities:

  • Behavioral Healthcare Providers (BHP)
  • Crosstown Surgery Center (Edina, MN)
  • Fairview Lakes Medical Center (Wyoming, MN)
  • Fairview Ambulatory Clinics
  • Fairview Maple Grove Ambulatory Surgery Center
  • Fairview Northland Medical Center (Princeton, MN)
  • Fairview Physician Associates (FPA)
  • Fairview Ridges Hospital (Burnsville, MN)
  • Fairview Southdale Hospital (Edina, MN)
  • M Health Ambulatory Surgery Center (Minneapolis, Minnesota)
  • University of Minnesota Health Clinics and Surgery Center is a joint venture owned by Fairview and University of Minnesota Physicians
  • Ridges Surgery Center (Burnsville, MN)
  • University of Minnesota Medical Center (Minneapolis, MN.) - including University of Minnesota Health Maple Grove Clinics
  • University of Minnesota Medical Center - Specialty Clinics (Minneapolis, MN), staffed by University of Minnesota Physicians

Scope of Services:

  • Collect and process applications for initial appointment, reappointment and additional privileges for all credentialed practitioners
  • Obtain primary source verification with medical school, residency program, previous hospitals, licensing board or other required sources
  • Identify and investigate red flags found during credentialing process
  • Process privilege forms and obtain required documentation
  • Maintain credentialing database and system-wide privilege forms
  • Ongoing monitoring and verification of license, malpractice insurance, DEA certificate and board certification for all applicable practitioners
  • Ongoing monitoring of sanctions or disciplinary actions such as licensure or Medicare/Medicaid sanctions
  • Maintain active and archived credentials files
  • Complete verification of Fairview membership and privileges for other organizations
  • Perform delegated credentialing for health plans
  • Assist in preparation and participate in credentialing portion of accreditation and regulatory surveys at contracted entities

Reappointment

Reappointment is the process of re-evaluating a practitioner's current competency after they have been appointed to the medical staff or professional staff at a Fairview entity.

Reappointment Process Steps

  1. Fairview System Credentialing Office Reappointment Staff will send each practitioner an electronic reappointment packet approximately five months prior to their reappointment expiration.
  2. Practitioners need to complete the reappointment form, checking whether the demographic information currently in our database is correct and completing new disclosure questions.
  3. Practitioners also must complete a privilege form indicating the privileges they want to perform upon reappointment. Documentation required for any requested privileges must be submitted with the reappointment packet.
  4. Fairview System Credentialing Reappointment Staff processes each practitioner’s reappointment upon receipt.
  5. Completed reappointments are sent to the Fairview entity(ies) Medical Staff Office for review and approval by the Board of Directors prior to the practitioner's reappointment expiration.
  6. A practitioner’s reappointment must be approved by the Fairview entity(ies) Board of Directors prior to expiration of the initial appointment or previous reappointment.
  7. Fairview reappoints each practitioner via a schedule based on first letter of last name. Some practitioners may be reappointed "out of sync" depending on their initial approval date in relation to the current reappointment schedule.
  8. Approval of both initial appointments and reappointments is for 24 months for Fairview hospitals and Clinics. These applications follow the Joint Commission hospital accreditation standards.
  9. Approval of both initial appointments and reappointments is for 36 months if applicant is only part of BHP or FPA provider networks. These applications follow the National Committee of Quality Assurance (NCQA) accreditation standards. 

Contact Information for Reappointment Staff

Reappopintments: 612-672-7700 and press 2

NCQA Reappointments (FPA and/or BHP membership only): 612-672-4284

Reappointments Office Fax 612-672-7733

Reappointments Office Email: fsco.reaps@fairview.org

Delegated Credentialing

Delegated credentialing is a formal process by which an organization gives another entity the authority to perform credentialing functions on its behalf.

Practitioners covered under Fairview’s delegated credentialing contracts with health plans do not have to submit credentialing paperwork to health plans. Practitioners get credentialed at Fairview and then Fairview submits the appropriate credentialing paperwork to the health plans. Practitioners are accepted into health plan provider panels the date of Fairview’s credentialing approval. A health plan may decide to credential the practitioner via their process instead of Fairview’s but this is a rare and usually occurs if there is something in the practitioner’s history that raises concern for the health plan.

By participating in delegated credentialing agreements, Fairview System Credentialing is required to meet NCQA (National Committee for Quality Assurance) credentialing standards. NCQA is the accreditation organization for health plans. In addition, health plans have a responsibility to audit Fairview’s credentialing policies and processes annually. Fairview System Credentialing also participates in the credentialing portion of a health plan’s NCQA accreditation survey. Fairview System Credentialing is an NCQA-Certified Credentials Verification Organization (CVO).

Benefits

Eliminates duplication and reduces costs because practitioners and their clinics do not have to complete a credentialing application for each health plan.

Enhances third party payer reimbursement for contracted entities because health plans accept Fairview's approval date(s) and primary source verification (versus waiting to go through an approval process by each health plan).

Contracted Health Plans

  • Araz Group/America's PPO
  • First Health/Coventry
  • HealthPartners
  • Humana
  • Metropolitan Health Plan
  • PreferredOne
  • South Country Health Alliance
  • UCare Minnesota
  • WEA Trust
  • Wisconsin Physician Services