Section 965.130  Use of Uniform Credentialing Forms

a)         The Department shall establish uniform forms for the purpose of credentialing, recredentialing, and information updates as required in Section 15 of the Act. The forms shall be coordinated to avoid the need for duplication of effort and information in submission.

b)         Hard copies and/or electronic copies of the forms shall be provided by the credentialing entity to applicants and current providers for use in their process.  Copies may be obtained through the Department electronically via the website at www.idph.state.il.us or in hard copy upon request.  No health care entity, health care plan, or hospital may require submission of the form in a specific format, either paper or electronic, until a date has been established under this Part whereby electronic submission can be required.

c)         Beginning January 1, 2002, all health care entities, health care plans, and hospitals that credential health care professionals shall only require the submission of the following forms, as specified in Section 15 of the Act:

1)         For credentialing, the Uniform Health Care Credentials Form (Appendix A).

2)         For recredentialing, the Uniform Health Care Recredentials Form (Appendix B).

3)         For updating credentials information, the Uniform Updating Form (Appendix C).

4)         Any additional credentials data requested.

d)         Credentialing and recredentialing applications and forms distributed before January 1, 2002 may continue to be accepted, but only through June 30, 2002. Health care plans, health care entities, and hospitals need not require that the forms adopted in this Part be filed for a health care professional whose credentialing is already in process prior to January 1, 2002.

e)         This Section does not prohibit or restrict the right of a health care entity, health care plan or hospital to request additional information necessary for credentialing or recredentialing.  (Section 15(i) of the Act) Nothing in this Part prohibits a pre-application process from being in place at a health care entity, health care plan, or hospital.  Individual attestation and release forms may be unique to each health care plan, hospital, or health care entity as a part of the credentialing or recredentialing process.

f)         The forms adopted in this Part cannot be altered in structure.  Nothing prohibits the use of pre-populated or double-sided forms as long as the structure of each page remains as adopted and as appearing on the Department website at www.idph.state.il.us.

g)         Nothing in the Act or this Part requires a health care entity, health care plan, or hospital to seek all of the credentials data that may be provided in the mandated credentials data gathering forms.  The extent to which a health care entity, health care plan, or hospital requires a health care professional to complete the applicable sections of the forms is within the discretion of the health care entity, health care plan, or hospital.  However, no health care entity, plan, or hospital may reject or deny a form that includes more information than the requirements of the individual entity, plan, or hospital.

h)         Keeping current and making changes in information, corrections, updates, and modifications to a health care professional's credentials data on file with health care entities, health care plans, and hospitals is the responsibility of the health care professional.  Data and information changes shall be submitted by the health care professional in accordance with the following time frames:

1)         Within 5 business days for state health care professional license revocation, federal drug enforcement agency license revocation, Medicare or Medicaid sanctions, revocation of hospital privileges, any lapse in professional liability coverage required by a health care entity, health care plan or hospital, or conviction of a felony.

2)         Within 45 days for any other change in the information from the date the health care professional knew of the change.  (Section 15(g) of the Act)

i)          All updates shall be made on the updating forms in Appendix C of this Part. (Section 15(g) of the Act) Updated information will be based on the information submitted to a health care plan, health care entity or hospital in the form in Appendix B of this Part.

j)          Collection of the information contained in the forms under this Part does not require health care entities, health care plans or hospitals to use all of the data and fields in the credentialing process. Nothing in the Act or this Part mandates whether or how credentials data must be verified or assessed as part of the credentialing process.  All decisions about whether and how to verify and assess any or all of the credentials data submitted to a health care entity, health care plan or hospital by a health care professional is exclusively within the lawful discretion of the health care entity, health care plan, or hospital that is credentialing that health care professional.

k)         Nothing in the Act or this Part prohibits a hospital from granting disaster privileges pursuant to the provisions of Section 10.4 of the Hospital Licensing Act.  When a hospital grants disaster privileges pursuant to Section 10.4 of the Hospital Licensing Act, that hospital is not required to collect credentials data pursuant to the Act.  (Section 15(m) of the Act)

(Source:  Amended at 32 Ill. Reg. 4040, effective February 27, 2008)