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Credentialing for Managed Care:
Compliant Processes for Health Plan
and Delegated Entities

Amy M. Niehaus, CPMSM, CPCS, MBA

New to managed care credentialing?

Whether you work for a health plan or a hospital medical staff services department, this how-to guide answers all of your health plan credentialing and enrollment questions. Learn the regulatory and accreditation requirements related to managed care credentialing, including those from CMS, NCQA, and URAC. Author Amy M. Niehaus, CPMSM, CPCS, MBA, provides readers with the guidance to create a comprehensive and compliant credentialing program to support your health plan or to streamline your hospital’s provider enrollment process through delegation.

Available August 2016

$160

This book will help you:

  • Understand NCQA, URAC, and CMS requirements for health plans
  • Develop a comprehensive and compliant managed care credentialing program
  • Establish delegated credentialing agreements
  • Audit credentials files
  • Recognize how payer credentialing requirements impact other healthcare organizations
  • Streamline provider enrollment through delegation
  • Identify the differences between hospital and managed care credentialing
  • Evaluate whether a credentials verification organization is right for your organization

About the Author

Amy M. Niehaus, CPMSM, CPCS, MBA, is a consultant with The Greeley Company, an industry-leading healthcare consulting firm. She has over 25 years’ experience in the medical services and credentialing profession. In her current role, she advises clients in the areas of accreditation, regulatory compliance, credentialing, process simplification and redesign, credentialing technology, and credentials verification organizations (CVO) development and delegation. Niehaus has worked in multiple environments throughout her career, including acute care hospitals, CVOs, and managed care organizations (MCO). She has been a member of the National Association Medical Staff Services (NAMSS) since 1991 and achieved her CPMSM certification in 1992 and her CPCS certification in 2002.

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