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Medical Credentialing

Do you really know your Doctor or Medical Personnel?

e-VERIFILE.COM has developed exciting new products, built specifically for Hospital Systems, Insurance Companies, Third Party Administrators and Network Plans, and Medical Practices to provide the most cost effective solution to the dilemma of credentialing medical providers.  e-VERIFILE.COM will customize a plan that will best suit your needs for one low rate.  Of course, you will always have access to single products whenever you need them for those out-of-the-ordinary cases.

Physician Profile

Information Contained in the Physician Profile are derived from:

		Medical Schools
		The American Medical Association (AMA) Medical Student File contains approximately 67,000 records, and it is updated annually through freshman matriculation, graduation and change of status reports. This information is reported to the AMA by each medical school director, unless by exception, a student does not pass from years 1, 2, and 3 on schedule. AMA receives the full name of each student, their school address, year and place of birth, gender, and school and year of graduation directly from each US medical school. Information received from The Liaison Committee on Medical Education (LCME)-accredited Canadian schools is stored electronically and is added to the file if the physician moves to the US. Graduation reports prepared by the osteopathic schools are supplied to the AMA by the American Osteopathic Association. This information is used to initiate a record on the AMA's medical student file. A unique record identifier, the medical education number (ME), is assigned to the record when the student enters medical school and can remain unchanged throughout that individual's career. Students are tracked for as long as it takes them to complete their undergraduate medical education.
		Residency Training Programs
		Each year the AMA conducts a survey of Graduate Medical Education (GME) Programs. Approximately 7,900 The Accreditation Council on Graduate Medical Education (ACGME)-accredited programs receive the electronic survey (on computer disk). Also surveyed are some 239 programs that offer medical specialty board-approved "combined specialty" programs. The survey collects data on over 97,000 individual residents in graduate medical education programs and is used to update physician records in the AMA Physician Masterfile.
		State Licensing Agencies
		The state licensing agencies issue approximately 45,000 licenses per year. Each of the 67 state medical and osteopathic boards provides AMA data on an ongoing basis. Licensure data is obtained at a minimum every 180 days. Most of the state boards provide: the degree (MD/DO); the date the license was initially granted; the expiration date (approximately 95% of all records have expiration dates); licensure status (active, inactive, denied or pending); and the licensure type (unlimited, limited or temporary). The "Last Reported" date is included on each profile to reflect the last time that data pertaining to that record was provided to the AMA from the individual licensing board.
		State Disciplinary Actions/Federal Sanctions
		The AMA processes disciplinary action reports received directly from the state medical boards and osteopathic boards. The AMA receives reports directly from: the Department of Health and Human Services in relation to Medicare and Medicaid regulations. AMA flags the physician's file with a star which appears on the physician's profile. A record is flagged if a license has been revoked, suspended, surrendered or has a stipulation of a disciplinary nature. For historical purposes, flags are never removed from the Masterfile. Over 300 physician records are flagged each month. The Profile refers the user to the state agency that took the action for further information.
		National Board of Medical Examiners Certification Year
		Medical students and physicians who have passed all parts of the National Board Examination are reported to the AMA by the National Board of Medical Examiners (NBME). NBME certification provides a permanent record of qualification for licensure. With the implementation of the United States Medical Licensing Examination (USMLE), the NBME will continue to issue its certificate based upon successful completion of a combination of NBME/USMLE examinations and any other requirements established and announced by the NBME. Such combinations will be accepted for medical licensure if completed prior to the year 2000. Annually, the NBME provides a computer tape with the names of physicians awarded national board certificates, along with their national board identification number, city, state, zip code, certification date, medical school and year of graduation.
		Educational Commission for Foreign Medical Graduates (ECFMG)
		Graduates of international medical schools who are located in the United States generally are incorporated into the Masterfile upon entry into an ACGME-accredited program of graduate medical residency training. Background information is supplied to the AMA by the ACGME-accredited programs and by the ECFMG.
		American Board of Medical Specialties
		Physicians certified by member boards of the American Board of Medical Specialties (ABMS) are reported to the AMA by the ABMS. The ABMS File provided to AMA includes the following information (as used in the following enumeration, the term "certification" shall also include certificates of special and/or added qualifications): the physician's name; the name of the certifying Board or Boards; the certification or sub certification awarded; the certificate type; the date of the original certification; sub certification and any recertification; and the date of expiration or revocation of the certification and any recertification AMA records carry only information on board certifications issued by boards that are recognized by the Liaison Committee for Specialty Boards (LCSB). The LCSB is comprised of members from the AMA Council on Medical Education and ABMS member boards.
		Federal Drug Enforcement Administration (DEA)
		DEA Registration is updated quarterly. The "as of" date reflects the last quarterly update. Many states require their own controlled substances registration/license, e-VERIFILE.COM as well, can obtain verification of these registrations.

National Practitioner Databank (NPDB)

• Information on medical malpractice payments
• Adverse licensure actions
• Adverse clinical privileges
• Adverse professional society membership actions
• Medicaid and Medicare exclusions

Healthcare Integrity and Protection Data Bank (HIPDB)

• Health care-related civil judgments taken in Federal or State court
• Health care-related criminal convictions taken in Federal or State court
• Injunctions
• Federal or State licensing and certification actions, including revocations, reprimands, censures, probations, suspensions, and any other loss of license, or the right to apply for or renew a license, whether by voluntary surrender, non renewability, or otherwise
• Exclusions from participation in Federal or State health care programs
• Any other adjudicated actions or decisions defined in the HIPDB regulations

Fraud and Abuse Control Information System® (FACIS®)

• The sanction history of individuals and entities in the healthcare field
• Reports provide a wide range of disciplinary actions from exclusions to letters of reprimand
• Queries individuals or entities with instantaneous results
• Database is updated twice per month with reporting directly from the Office of Inspector General (OIG) and General Services Administration (GSA)

In addition to the search results for FACIS®,  an automatic search will be performed against information on the Office of Foreign Assets Control (OFAC) and Specially Designated Nationals and Blocked Persons (SDN) List. You can avoid entering into business/financial transactions with individuals/entities that appear on the list of OFAC and SDN.

This List contains the names and aliases of individuals/organizations that have had financial transactions and property blocked by the U.S. Department of Treasury, OFAC. It is part of the anti-terrorist campaign of the Federal government.

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