Mercy Hospital Medical Staff Credentialing Manual - Mercy Health

CREDENTIALING MANUAL REVISED AND APPROVED BY THE BOARD OF DIRECTORS JANUARY 24, 2008b. Trainingc. Licensure/Certificationd. Experiencee. Current Competencef. Collaborative Agreement (Advanced Practice Nurses), Physician Supervisory Plan(Physician Assistant)g. Continuing Educationh. Requirements for Supervisioni. Professional Referencesj. Ability to Performk. Identification of medical staff member(s) providing supervision/sponsorshipl. Evidence of continuing comprehensive professional liability insurance coverage in theamount of $1,000,000/ $3,000,000. (If an AHP is covered under the employingphysician’s policy, the AHP must submit documentation from the professional liabilityinsurer which acknowledges coverage for the physician’s employment or supervision ofAHPs and, if the physician group employs the AHP, indicates that the specific AHP, byname, is covered by the policy in the amounts required in this Plan.)APPLICATION PROCESSA. Release of ApplicationAn AHP shall be provided an application only where an Mercy Health Partners HospitalGoverning Board has approved the AHP category/profession and an appropriate categorydescription.B. Application and FeeAHPs shall be credentialed in accordance with this Plan and shall bear the actual costs of thecredentialing process. AHPs must complete the State of Ohio application form in its entiretyalong with Mercy Health Partners supplemental forms, attestation, release and other relateddocuments, and submit the application fee.C. Burden of Providing InformationAHPs shall have the burden of producing information deemed adequate by Mercy HealthPartners for a proper evaluation of current competence, character, ethics and other qualificationsand for resolving any doubts about such qualifications. An application is not complete unlessthe application form is completed, all items required to be verified are completed, and anyadditional information necessary to evaluate the applicant’s qualifications has been provided. If,after 30 days (from the date of signature), the application is incomplete due to outstandinginformation, documents, verification/references, the application shall be automaticallywithdrawn, and the applicant shall be notified that the application will not be considered.23