The primary goal of DGMC's Credential Staff, and of the Credentialing and Privileging process, is to protect you, the provider, our patients and our facility. We ensure that all of the credentials are IAW AFI 44-119 and meet Joint Commission standards. It is also our goal to have you practicing what you have been trained to do as soon as possible.
What is Credentialing? Think "Certificates." Credentialing is the process of obtaining, verifying, and accessing the qualifications of a health care provider to provide patient care services. Credentialing is based on four core criteria:
- Current Licensure;
- Relevant Education, Training, or Experience;
- Current clinical competence, and;
- Ability to perform requested privileges.
What is Privileging? Think "Permission." Privileging is granting you the permission to provide medical care services within defined limits. It allows you to practice what you have been trained to do.
Who are the privileged providers? A privileged provider is one who initiates, monitors or can stop a course of treatment.
What is the Application Process? Regardless of what AF MTF you are assigned to practice, the following items are required.
- Medical Staff Guide
- AF Form 1540 / E-app
- AF Form 1541
- AF Form 1562
- By-laws
- Privilege list
- Interview with SGH
Coming out of a Residency/Fellowship Training Program? If you are joining us from a training program, you are required to also have:
- AF Form 494/475
- Privilege list (completed by your program director)
- AF Form 1562 (completed by your program director)
We cannot privilege you without these items!
Contractor/Volunteer? Depending on your contract, you may also need the following:
- AF Form 1562 or reference letters (3)
- Initiate a CHBC (Criminal History Background Check)
- Proof of insurance (if applicable)
Certificates
If you are initiating your provider credential file (PCF) at the 60th Medical Group, you may also be responsible for supplying documents pertaining to your education, training, and competence. These items/certificates may include:
- Degree
- Internship/Residency/Fellowship
- Aerospace Medicine Primary Course
- Board Certification
- Conscious Sedation References (if applicable) from a Program Director, Clinical Supervisor, and Department Chair
- Current licensure/certification
- All providers must have BLS
Additionally, depending on your specialty, we may require:
- ACLS
- ATLS
- PALS
- NRP
What is the DEA requirement? All providers who are required to have a DEA must have a DEA registration. DOD fee-waived initiative applies to Physicians, DO's, Dentists, Podiatrists, and now, Nurse Practitioners, and Physician As-sistants who meet the criteria. Providers are not authorized to use a facility DEA. That number is used by the pharmacy to order drugs for the facility. Your DEA registration will transfer with you from one MTF to another and one must relinquish your registration upon separation or retirement from military practice. If you are a new provider eligible for a DEA (fee-exempt) registration, and have not applied for your DEA registration, an application will be provided at this time. These original registrations are kept in your credential file.
Electronic Privileging? All DoD facilities were mandated to transition to electronic privileging by April 2009. Each provider will be issued a CCQAS userid & password for completing an online e-application. Instructions & assistance will be provided by the Credentials office.
What's taking so long? There are a number of reasons which could cause a delay in processing your application:
- Incomplete application
- Missing documentation
- Delay in receiving verification
We ask your assistance to ensure your application is complete, all supporting documentation is included and have provided explanations if needed.
What happens next? Once your e-app /application is returned to our office, it is checked for completion and accuracy. Primary Source Verification is done on all certificates and licensure. NPDB/HPDB and FSMB (if applicable) queries are completed. A Provider Credential File is created and the review process will begin.
What is the Review Process? Your file will be reviewed electronically and signed by your clinical supervisor, department chair, SGH and the Commander who, based on recommendations of the credentials function, will award privileges.
When can I see patients? You may not engage in patient care until you get notified by the Credentials Office to come and sign your appoint-ment letter. Your signature completes your portion of this process.
What about CHCS? Access in CHCS is not granted until the entire process is complete. Your signature is required before you are given CHCS permission.
Your Credential File is extremely important. This will follow you through out your Military career. It is your responsibility to keep your file current at all times. Therefore, you are encouraged to review and update your file on a regular basis. Remember, this is your responsibility.
* A Provider must have a valid and unrestricted license at all times.
Credentialing and Privileging Checklist
Graduating Resident/New Provider (for explanation of forms, see below)
□ AF Form 494/475
□ Privilege List (completed by program director)
□ AF Form 1562 (1)
□ Degree
□ Certificates
□ License/certifications
□ Interview w/SGH (scheduled?)
□ BLS and ACLS,PALS,NRP (if applicable)
□ AF Form 1540 (E-application completed, reviewed and e-signed
□ By-laws
□ Privilege list--Electronically (Fully Competent /With Supervision or manual, if applicable, (completed by applicant according to directions using codes, 1, 2, or 4)
Joining us from another facility
Your PCF should have been forwarded to us from your previous MTF. Once your file is received, it is reviewed for completeness. An incomplete file, w/o (3) AF 1562's appropriately completed, an AF Form 22 and current in BLS, and ACLS, ATLS, PALS, NRP (if applicable), will cause a delay in processing. You must complete an application for privileges, a new privilege list and meet the same requirements as others applying for privileges. (Electronic E-app required when applicable) CaC card is required.
Civilian/IMA /USAFR /Volunteer
□ AF Form 1540
□ AF Form 1562/reference letters (3)
□ By-Laws
□ Interview w/SGH
□ All required documentation/license/certifications
□ Civilian Privilege List (Civilians/USAFR/IMA's)
□ SP 85 (Criminal History Backround Check-
(Civilians/Volunteers) if applicable.
□ Proof of Insurance (civilians, if applicable)
Before signing your application, please review it for completion. Please be sure all signatures, explanations, (if necessary) are complete and that all of the required documentation is included.
Frequently used Forms and Terms:
CCQAS - Centralized Credentials Quality Assurance System
AF Form 494/475 - Training evaluation
AF Form 1540 - Application for Clinical Privileges.
AF Form 1541 - Continuing Health Education
AF Form 1562 - Evaluation of a Health Care Provider
Privileging List - A delineation of privileges a provider is allowed to perform.
Provider Activity File (PAF) - A file maintained by your department to reflect current activity and performance.
Provider Credential File (PCF) - A six-part folder maintained in the Credentials Office. This file holds your application, evaluations, Malpractice, CME, Certificates, license etc. These files are monitored & it is your responsibility to reflect the most current information
The Credentialing/Privileging Process can be very frustrating at times. Hopefully, the information we have provided will help you to understand our process. We are committed to making this process a pleasant experience. If you have any questions, please do not hesitate to contact us. Our staff is here to serve you. Thank you and welcome to Travis!
Mailing Address:
60th MDG/SGHQ
101 Bodin Circle
Travis AFB, CA 94535-1800
Phone: (707) 423-7611
(707) 423-7113 (New Applications)
(707) 423-3490 (Reappointments)
Fax: (707) 423-3260
DSN: 799-3260