Expiring Malpractice Insurance: What’s That Rule Again?

Confused Doctor

The time between when a provider signs their attestation and when the provider’s file goes to committee for review can often mean that dates, such as malpractice insurance expiration, have come and gone.

But what is the actual NCQA rule around this?

And what’s right for your organization?

We’ve had a number clients ask us what the actual NCQA requirement is. One of our clients received conflicting information from a third-party about what was required, and each client that asked was interested in understanding the specific rule.

It goes without saying that in order to make the right decisions for your network, you have to first know the parameters you’re working within. We refer to this as “thinking outside the box but inside the framework.”

Malpractice Insurance Standards, According to NCQA

From our direct conversations with NCQA, we know that as long as malpractice insurance is current at the time of provider attestation, it is considered a compliant application. This means that it is technically okay if the malpractice license on record is expired at the time of committee review.

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Malpractice Insurance Standards, According to Your Bylaws

It’s up to the plan to decide what’s best for its network and we’ve structured our credentialing process to be flexible enough to meet the varying needs. Flexibility also helps in instances where regulations or a plan’s internal bylaws change.

We have clients who decide that sticking to the NCQA requirement works best. We have other clients that want to go further.

In the example where our client received conflicting info from a third-party, that third-party told them they needed to go as far as ensuring that insurance was valid at time of committee review. When we clarified the actual rule, we worked with them to determine that for them it makes sense to instead ensure that it’s current at the time of application review. If it’s not current at that time, the outreach team (whether that’s us or the client) will request proof of updated insurance before the provider moves forward in the process.

This decision allows the client to go above and beyond their due diligence on this piece of the process while making a decision that works from both a process and fiscal standpoint.

Questions about a standard?

Send us a message and we’ll see how we can help.

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