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Credentialing Service Agreement for the United States

Credentialing Service Agreement Template for United States

A Credentialing Service Agreement is a legally binding contract used in the United States healthcare sector that establishes the terms and conditions under which a credentialing service provider will verify and manage the credentials of healthcare professionals. The agreement ensures compliance with federal regulations including HIPAA, state-specific credentialing requirements, and accreditation standards such as NCQA and Joint Commission requirements. It outlines the scope of services, performance standards, data protection measures, and compliance obligations.

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What is a Credentialing Service Agreement?

The Credentialing Service Agreement is essential in modern healthcare operations where organizations must verify and monitor the qualifications of their medical staff. This document becomes necessary when healthcare organizations seek to outsource their credentialing processes to specialized service providers. The agreement ensures compliance with U.S. federal and state regulations, accreditation requirements, and industry standards. It typically includes detailed service specifications, performance metrics, data security protocols, and compliance requirements. This type of agreement has become increasingly important with the growing complexity of healthcare regulations and the need for efficient, standardized credentialing processes.

What sections should be included in a Credentialing Service Agreement?

1. Parties: Identification of the credentialing service provider and the healthcare organization/client

2. Background: Context of the agreement and purpose of the credentialing services

3. Definitions: Key terms used throughout the agreement including regulatory and industry-specific terminology

4. Scope of Services: Detailed description of credentialing services to be provided and service provider responsibilities

5. Term and Termination: Duration of agreement and conditions for termination or renewal

6. Fees and Payment Terms: Pricing structure, payment conditions, and invoicing procedures

7. Compliance Requirements: Regulatory and accreditation compliance obligations including HIPAA, HITECH, and state-specific requirements

8. Confidentiality and Data Protection: Data protection, privacy requirements, and confidentiality obligations

9. Standard of Performance: Service level requirements, performance metrics, and quality standards

What sections are optional to include in a Credentialing Service Agreement?

1. Delegation of Authority: Specific powers and responsibilities granted to the credentialing service provider

2. Technology Requirements: Technical specifications, system requirements, and software compatibility requirements

3. Disaster Recovery: Business continuity planning, data backup procedures, and emergency protocols

4. Training Requirements: Staff training, certification requirements, and ongoing education obligations

What schedules should be included in a Credentialing Service Agreement?

1. Schedule A - Service Level Agreement: Detailed performance metrics, standards, and service level commitments

2. Schedule B - Fee Schedule: Detailed breakdown of all fees, charges, and payment terms

3. Schedule C - Data Security Requirements: Specific security protocols, requirements, and compliance standards

4. Schedule D - Required Documentation: Comprehensive list of documents required for the credentialing process

5. Schedule E - Compliance Checklist: Detailed checklist of regulatory and accreditation requirements

6. Schedule F - Key Contacts: List of key contacts and responsible personnel for both parties

Authors

Alex Denne

Head of Growth (Open Source Law) @ Ƶ | 3 x UCL-Certified in Contract Law & Drafting | 4+ Years Managing 1M+ Legal Documents | Serial Founder & Legal AI Author

Jurisdiction

United States

Publisher

Ƶ

Document Type

Service Agreement

Cost

Free to use
Clauses






























Industries

HIPAA: Health Insurance Portability and Accountability Act - Federal law governing healthcare privacy, security, and data transmission standards

HITECH Act: Health Information Technology for Economic and Clinical Health Act - Expands HIPAA requirements and establishes standards for electronic health record systems

Fair Credit Reporting Act: Federal law regulating the collection, dissemination, and use of consumer information, including background checks in credentialing processes

Americans with Disabilities Act: Federal law protecting rights of individuals with disabilities, impacting credentialing decisions and reasonable accommodations

State Medical Practice Acts: State-specific laws governing medical practice, licensing requirements, and professional standards

NCQA Standards: National Committee for Quality Assurance requirements for credentialing and provider verification processes

Joint Commission Standards: Accreditation standards for healthcare organizations, including credentialing requirements

URAC Standards: Utilization Review Accreditation Commission standards for healthcare quality and credentialing

CMS Guidelines: Centers for Medicare & Medicaid Services requirements for provider enrollment and credentialing

State Data Protection Laws: State-specific requirements for protecting sensitive information and handling data breaches

Professional Liability Requirements: State-specific malpractice insurance requirements and risk management guidelines

State Contract Laws: State-specific contract formation, enforcement, and interpretation requirements

Teams

Employer, Employee, Start Date, Job Title, Department, Location, Probationary Period, Notice Period, Salary, Overtime, Vacation Pay, Statutory Holidays, Benefits, Bonus, Expenses, Working Hours, Rest Breaks,  Leaves of Absence, Confidentiality, Intellectual Property, Non-Solicitation, Non-Competition, Code of Conduct, Termination,  Severance Pay, Governing Law, Entire Agreemen

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