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DHP CREDENTIALING GUIDE

9/14/16 * Please Note: Credentials and Requirements could change without notice.* 1

This guide contains all credential requirements for DHP HealthTrust Credentialing. Not all facilities (within Divisions) require the same credentials. This guide is intended to inform about any and all credentials as well as other information that may be useful in the credentialing process.

Index (jump to links)

Updates Summary Page 2

DHP Overview Page 3-4

Tier Core Requirements Page 5

Division Requirements Page 6

DHP Request for Enrollment Form Page 7

Credentials and Requirements Pages 9-22

Credentials Located in eDHP System

Company/Individual Information Needed

Classifications that require a Competencies/Skills Checklist

Healthcare Training

Certificate of Insurance

Background Report Requirements (including Mississippi, Missouri, Alaska, Nevada)

Background Check Provider Option

How to Complete the Additional Background Requirements-Missouri

How to Complete the Additional Background Requirements: Alaska

Health Requirements

Payments Page 20

System & Process Information Page 20-21

Types of File Processes

Contact Information Page 22



Updates Summary (Back to Index)

This section is to briefly inform you of the updates, changes and clarifications made to this version of the DHP Credentialing Guide as of 9/14/16.

What Does our Becoming Part of HealthTrust Mean for You? The most important thing for you to know is that you won’t see any changes on a day-to-day basis. You’ll continue to work with the same support staff as you have before.

This rebrand will not impact your credentialing status.

Welcome to HealthTrust Workforce Solutions, an organization committed to positively impacting patient care, employee satisfaction and workforce efficiencies.

New Division Joining DHP HealthTrust – October 3, 2016 San Antonio Division will be live with eDHP October 3, 2016. The first wave of DHPs will be Scribes and Tier 3

sponsored DHPs. Wave 2 will go live November 17, 2016, which will be the remaining population of DHPs.

We are reaching out to all of our valued healthcare professionals to make sure you heard the news — that we are changing our name to HealthTrust Workforce Solutions (from Parallon Workforce Solutions).

As our new name implies, we are now more closely aligned with the HealthTrust Purchasing Group – which has been partnering with healthcare facilities for decades.

So it makes perfect sense that we take the HealthTrust name, which we think is a perfect fit for the long-standing relationships we have with our vendor partners and their healthcare professionals– partnerships based on mutual trust, values and objectives.

As HealthTrust Workforce Solutions, we focus on the most important part of a healthcare organization’s ability to deliver exceptional patient experiences – its people.



(Back to Index)

Non-employee Dependent Healthcare Professionals (DHPs) DHPs are a subset of all “staff” providing services at the facility, as defined in the Glossary of the Comprehensive Accreditation Manual for Hospitals, published by TJC. This concept of staff and the related facility responsibilities is consistent with the requirements of AAAHC and CMS. These individuals are not in scope:

• HCA employees • APP/LIP (we must credential to the highest level of licensure regardless the role the DHP serves in the facility) • Volunteers • Students • Interns • Remote workers who do not provide patient care services • Sexual Assault Nurse Examiner (SANE) (Mountain/MidAmerica Division Only) • Organ Procure Organizations

These individuals may be employed by a contractor, a temporary staffing agency, a privileged practitioner or practitioner group or be directly contracted by a patient for a specific service. Upon facility approval and compliance, In order to gain access to HCA facilties DHPs are to log into the eDHP Kiosk Badging System and print their badge at their respective facility on each occasion to provide services. **Pharmaceutical Representatives are granted access based on a pre-defined pharmaceutical related policy. If you are a Pharmaceutical Representative you must contact your local Division Director of Pharmacy to get approval for access.

DHP HealthTrust will not verify work history at HCA facilities to third parties for DHPs. DHPs should not list HCA facilities as a hospital affiliation on their applications for other facilities.



Tier Level Definitions (Back to Index)

Level Approver Level Definition Tier 1/ Non-Employee

Not a patient care provider, but entering safety or security sensitive areas of the facility

This Tier of non-employees may provide services other than patient care services but to do so, would need to enter a safety- or security-sensitive area of the facility. Since a Tier 1 Non-employee does not meet the TJC definition of “staff,” the vetting and authorization procedures are limited to serving the purposes of ensuring safety, security and access control.

Tier 2/DHP Professional that may be approved by hospital management staff

An individual who meets the definition of a DHP and who provides clinical services and/or direct hands-on care requiring the involvement and supervision of a member of the clinical staff of the facility (i.e., CNO/CNO designee for the approval of DHP nurses), in the services they provide. This Tier includes DHPs who will provide clinical instruction to the clinical staff of the facility (e.g., vendors providing product instruction to physicians, nurses, or other clinical staff) that would directly impact their delivery of patient care.

Tier 3/DHP Professional that must be approved by both hospital management and medical staff

An individual who meets the definition of a DHP and who provides clinical services and/or direct hands-on care requiring the involvement and supervision of a physician or other licensed independent practitioners (LIP) in the services they provide.



TIER CORE REQUIREMENTS (Back to Index)

TIER 1 TIER 2 & 3 • Online Application & Acknowledgement

Card/Addendum (located online) • Legal Agreement (located online) • Photo ID • Confidentiality and Security Agreement (located

online) • Chest X-Ray - TB Annual Signs/Symptoms Form • TB Test (see division requirements) • Job Description • Letter of Compliance (Verification of

employment and date of hire) • Background Check Results for the following:

o Social Security Number Verification o Criminal Search Verification o Violent Sexual Offender o OIG/GSA List of Excluded Individuals o OFAC SDN Search San Antonio has a 30 day requirement

• Flu Vaccine (when applicable) • Annual Credentialing Fee (paid online)

• Online Application & Acknowledgement Card/Addendum • Legal Agreement (located online) • • Photo ID • Confidentiality and Security Agreement (located online) • Scope of Service documentation (located online) • Letter of Compliance (Verification of employment/date of

hire/training and competencies) • HIPAA Training • OR Protocol Training/AORN (only IF WORKING in the OR) • Skills Checklist/Competencies (Clinical DHPs) • Job Description • Background Check Results for the following:

o Employment History Verification (7 yrs) o Criminal Search Verification (7yrs) o Education – Highest level attained (clinical and/or

required on SOS) o Social Security Number Verification o Violent Sexual Offender o OIG/GSA List of Excluded Individuals o OFAC SDN Search

San Antonio has a 30 day requirement • Licensure/Certification Verification [state boards and will

be PSV by PWS] (when applicable) • Chest X-Ray - TB Annual Signs/Symptoms Form (where

applicable) • TB Test (see division requirements) • Certificate of Insurance • Flu Vaccine (when applicable) • Annual Credentialing Fee( paid online)

Forms are Located: Location to DHP Forms

https://staffrx.app.medcity.net/StaffDHP.Net/Documents/dhpresources.html



DIVISION REQUIREMENTS (Back to Index)

DIVISION Tier 2 & 3 Tier 1

All Tiers Must Complete Division Orientation

CAPITAL Drug Screen, MMR, Varicella, Hepatitis B, TDap

CONTINENTAL Drug Screen, MMR, Varicella, Hepatitis B

DELTA Drug Screen Garden Park Only: Mississippi Fingerprint clearance letter (letter must be less than 2 years old) MA- Annual Safety Training Manual

MA- Annual Safety Training Manual

FAR WEST Drug Screen, MMR, Varicella, Hepatitis B, TDap

GULF COAST Drug Screen, TDap

MIDWEST Drug Screen, MMR, & Orientation – Must add MIDWEST DIV area MA- Annual Safety Training Manual, Missouri Hospitals Only : MO EDL Exclusion List (web search) MO State Hwy Patrol

Must add MIDWEST DIV AREA MA- Annual Safety Training Manual

NORTH FL Drug Screen, MMR, Varicella, Hepatitis B

EAST FL No Additional Requirements

WEST FL No Additional Requirements

TRISTAR Drug Screen, MMR, Varicella, Hepatitis B

MOUNTAIN TB Test required upon initial credentialing only (All Tiers), Alaska Regional Only: State Background Check & Drug Screen (All Tiers)

SOUTH ATLANTIC Drug Screen, MMR, Varicella, Hepatitis B

South Carolina Hospitals (Colleton MC, Grand Strand Regional MC, Trident MC): TB test upon initial credentialing must be dated within 90 days of application submitted date. (All Tiers)

C&W TEXAS Drug Screen

NORTH TEXAS Drug Screen, MMR, Varicella, Hepatitis B, TDap & Orientation

SAN ANTONIO Negative TB Skin Test or Tspot & Questionnaire (no chest xray) MMR, Varicella and HEP B must follow vaccine schedule (Titers acceptable) TDap N-95 (Aurora 1870+) Respiratory Mask Fit testing Drug Screen – must be completed within 30 days of DHP credentialing enrollment San Antonio has unique exemption forms that must be used when and where appropriate.

Negative TB Skin Test or Tspot & Questionnaire (no chest xray)



Form Located: Location to DHP Forms

DHP Request for Enrollment Form (Back to Index)

Complete and email to: [email protected]




Credentials and Requirements (Back to Index) Credentials Located in eDHP System: Online Application & Acknowledgement Card/Addendum

o This is the setup of your account and attesting to terms and conditions. o Reoccurrence: Annual

Scope of Service Form Review o A form describing the range of duties within a particular set of negotiations leading to a collective agreement. o Reoccurrence: Annual

Form must be signed and dated; outdated forms are not acceptable. Classification and Division specific form available for various Divisions – available on the DHP website located

here If a scope of service for your classification is not listed, please use the Interim Scope of Service Form. Only one Tier must be selected on this form.

MidAmerica Annual Safety Training

o Formal document created to assist in understanding the key components of MidAmerica’s safety and emergency preparedness procedures. Training is available here

o Reoccurrence: Annual Division Orientations

o Orientations are available for the following Divisions; The below Divisions are available online via eDHP o Reoccurrence: Once upon initial application

Capital North Texas Mountain Continental Central & West Texas Far West TriStar Gulf Coast MidAmerica (Midwest & Delta) East, North, West Florida San Antonio South Atlantic

Company/Individual Information Needed: (Back to Index)

Letter of Compliance (LOC) Tier’s 1, 2, 3

o All Tiers - A letter that confirms the DHP is employed by the company and should include the date of hire (DOH). o Tier 2 and 3 – the letter should include training and competencies with the current employer to perform their duties. o Reoccurrence: Once upon initial application

Letter must be on company’s letter head, signed and dated by the appropriate DHP’s Supervisor/ Manager. There is no timeframe in which the letter is to be dated.

If the DHP is self-employed they may write their own LOC. In addition, the DHP will be required to provide proof of business ownership through primary source verification (i.e. 1099) or listed on state website (i.e. Sunbiz for FL, etc.)

If the DHP represents more than one Agency, they must have multiple LOCs or each Agency must be listed within one LOC.


https://staffrx.app.medcity.net/StaffDHP.Net/Documents/pdf/ORIENTATION/MidAmerica_Annual_Safety_Training_Manual.pdf



Credentials and Requirements (Back to Index)

Company/Individual Information Needed – con’t Job Description (Back to Index)

o Formal document outlining job responsibilities, functions and requirements of the DHP’s position o Reoccurrence: Once upon initial application

o What to include on the document: Company letterhead/ Logo/ Company Name Title of Job/Position Must be typed and legible

o Please do not submit JDs tailored for non-HCA facilities or Physician based practices o Elements to include but not limited to:

Basic responsibilities Qualifications

• License, Certification, Education Skills

Government Issued Photo ID

o Reoccurrence: Once upon initial application o Acceptable forms of identification are: Military ID, Driver’s License, & Passport. o Must not be expired o The full form of identification must be visible and legible. o 2x2 headshot or any other pictures are not acceptable as form of identification. We must have on file a photo ID and the

2x2 photo.

Headshot Photo o Reoccurrence: Once upon initial application o Clear, frontal headshot with light background. Photo needed for eDHP Kiosk badging system

Competencies Skills Checklist (Clinical DHPs)

o An evaluation completed by the employer that shows proof of current assessment done on the DHP and their competency skills to perform their job.

o Reoccurrence: Annual

Company does NOT have a standardized checklist: Experienced employees will complete Section A. Newly hired employees will complete both Sections A and B.

Company has a standardized checklist:

If company has a standardized checklist (same/similar) to use for experienced and/or newly hired DHPs, that document may be submitted to satisfy the credential.

a. Newly hired DHPs who have not achieved/passed/completed training required for the position (not the company related training), would need to complete checklist will need to contain same information as Part B of this document. If the documentation does not, then the company needs to complete page 3 and submit with their document.

Must be completed within the last year. The Title of the evaluator must be clear and legible.



Classifications that require a Competencies/Skills Checklist (Back to Index)

Y- Indicates a requirement for a Competencies/Skills Checklist. Left Blank indicates it is not a requirement. Acupuncturist Y Acute Culture Technician Y Acute Materials Transporter Administrative Assistant Admissions Liaison Admissions Nurse Y Anesthesia Care Coordinator Y Anesthesia Technician Y Apheresis Nurse Y Apheresis Nurse Supervisor Y Athletic Trainer Y Audio Testing Technician Y Audiologist Y Autopsy Assistant Y Autotransfusionist Y Bariatric Nurse Y Billing Coordinator BioMedical Technician Brachy Therapy Specialist Y Cardiac Nurse Y Cardio Vascular Tech- Noninvasive

Y

Cardio Vascular Tech - Invasive Y Cardiovascular Perfusionist Y Care Coordinator Y Case Management Assistant Y Case Manager - Clinical Y Cast Tech Y Cath Lab Director Y Cellular Therapy Manager Y Cellular Therapy Specialist Y Certified Hyperbaric Technologist Y Certified Massage Therapist Y Certified Music Therapist Y Certified Nuclear Medicine Tech Y Certified Nurse Operating Room Y Certified Nursing Assistant Y Certified Occupational Therapist Y Certified Ophthalmology Assistant

Y

Certified Orthoptist Y Certified Registered Nurse First Assist

Y

Certified Surgical Assistant Y Certified Surgical First Assist Y Certified Surgical Scrub Tech Y Certified Surgical Tech Y Certified Surgical Tech First Assistant

Y

Chaplain Clinical Liaison Y Clinical Neurophysiologist Y Clinical Nurse Manager Y Clinical Nutrition Manager Y Clinical Program Manager Y Clinical Program Manager-Wound Care

Y

Clinical Research Associate Y Clinical Research Coordinator Y Clinical Research Coordinator Assistant

Y

Clinical Science Liaison - ABATE Project

Y

Clinical Technician Y Coder/Biller Coder/Biller - Remote Access Compliance Specialist Concurrent Review RN Y Courier Cosmetologist Crisis Care Lic Vocational Nurse Y CryoTech Y Cyto Technologist Y Data Collector Dental Assistant Y Dental Hygienist Y Diagnostic Medical Sonographer Y Diagnostic Sonographer Y Dialysis Coordinator Y Dialysis Nurse Y Dialysis Nurse - LPN Y Dialysis Nurse - RN Y Dialysis Tech Y Dialysis Tech-PCT Y Dialysis Transporter Y Diener Y Dietitian Y Discharge Dictator Y Discharge Dictators -Remote Access

Y

Discharge Nurse Y Discharge Summary Assistant Y Dosimetrist Y Doula Y Driver Echo CV Tech -Non Invasive Y Echo Tech Y ECMO Technician Y

Educator Y EEG Technician Y EFL- Dialysis Nurse Y EFL- Dialysis Tech Y Embryologist Y Endoscopy Technician Y Environmental Services Aide Environmental Services Coordinator

Equipment Assistant Ethicist Y Executive Chef Field Service Tech Genetic Counselor Y GI Rounding LPN Y GI Rounding RN Y Greeter Grief Counselor HCIR - Healthcare Industry Rep HCIR - Pharmaceutical Representative

Healthcare Industry Rep Manager

Histo Technologist Y Histology Technician Y Hospice Nurse Y Hospice Representative Y Hyperbaric Technician Y Industrial Hygiene Technician Infusion Nurse Y Insurance Case Manager Interpreter Y Interventional Breast Procedure Biopsy Aide

Y

Interventional Nurse Y Intraoperative Neuromonitoring (IONM) Specialist I- No Cert

Y

Intraoperative Neuromonitoring (IONM) Specialist II

Y

Inventory Technician Investigator - ABATE Project Y IT Support Laboratory Assistant Y Lactation Consultant Y Laser Technician Y Licensed First Surgical Assistant Y Licensed Medical Health Physicist Y Licensed Mental Health Counselor

Y

Licensed Physical Therapy Y



Assistant Licensed Professional Counselor Y Licensed Radiology Tech Y Licensed Social Worker Y Licensed Surgical Assistant (LSA) Y Licensed Vocational Nurse Y Lithotripsy RN Y Lithotripsy Tech Y LPN-Rounding Nurse Y Maintenance Tech Massage Therapist Y Medical Assistant Y Medical Photographer Medical Physicist Y Medical Technician Y Mental Health Assessor Y Mobile Service Provider Neonatal Photographer Neurodiagnostics Tech Y Neurophysiologist Y Newborn Hearing Screener Y Non-Certified Surgical Scrub Tech Y Non-certified Surgical Tech Y Occupational Therapist Y Ocularist Y Oncology Nurse Y Operating Room Nurse Y Ophthalmic Tech Y OR Technician Y Ortho Tech Y Orthopaedic Physician Assistant Y Orthopedic Technician Y Orthotist Assistant Y Ostomy Care Nurse Y Outreach Specialist Y Pathology Assistant Y Pathology Tech Y Patient Advocate

Patient Care Coordinator Y Patient Care Technician Y Patient Representative Y Pedorthist Y Perfusion Assistant Y Pet-CT Technologist Y Pharmacist Y Pharmacy Technician Y Phlebotomist Y Physical Therapist Y Physical Therapist Assistant Y Physical Therapy Aide Y Physical Therapy-Rehab Tech Y Physicist Assistant Y Picc Line Nurse Y Polysomnographic Tech Y Pre OP Nurse Y Privately Employed Scrub Y Program Coordinator Y Program Director Prosthetist/Orthotist Y Psych Nurse Y Psychometrist Y Psychosocial Specialist Y Radiation Inspector Y Radiation Physicist - Medical & Nuclear

Y

Radiation Therapist Y Radiologic Tech Y Radiology Clerk Y Radiology Consultant Y Recreational Therapist Y Registered Nurse First Assist Y Research Coordinator Y Respiratory Therapist Y RN CCL Nurse Y RN Clinical Liaison Y RN First Surgical Assist Y

RN Massage Therapist Y RN Rounding Nurse Y RN Special Care Unit Y Scribe Y Scrub Tech Y Security –APO Security Guard/Driver Senior Coordinator - ABATE Project

Y

Service Specialist Sexual Assault Nurse Examiner Y Sitters Sleep Technician Y Social Worker Y Sonographer Y Speech Language Pathologist Y Surgical Assist (Non Certified and Non Licensed)

Y

Surgical Assistant Y Surgical First Assistant Y Surgical Technician Y Surgical Technologist (SA) Y Surgical Technologist (ST) Y Surgical Technologist-Assistant Y Technical Specialist Y Transcriber Y Transition Care Coach Y Transition Coordinator Y Transporter Ultra Sound Tech Y Unit Assistant Vascular Access Nurse Y Videographer Wound Care Tech Y Wound Specialty Nurse Y



Healthcare Training (Back to Index) Operating Room Protocol Training

o A Certificate or attestation from their current employer (or a statement which can be included in the letter of compliance) attesting to the DHP required training in the Operating Room Protocol and aseptic techniques.

o Reoccurrence: Once upon initial application, unless undergoing the Vendor Change Process: Types of File Processes Only applicable to DHPs requesting access to the Operating Room Certificates of training may be accepted by a qualified vendor organization The certificate must include the vendor company logo, person’s name testing, name of training and date

completed. DHP HealthTrust also provides an Attestation of Satisfactory AORN Requirements form that can be completed by

the DHP’s employer – form available here Company Policies are not acceptable without the confirmation of the DHP’s training along with their completion

dates. If self-employed, please provide actual certificate. Statement from DHP is not acceptable – Please visit

www.HIPAAExams.com to obtain training and certificate

HIPAA Training o A Certificate or attestation from their current employer (or a statement which can be included in the letter of

compliance) attesting to the DHP’s training in Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy and Security Rules

o Reoccurrence: Once upon initial application, unless undergoing the Vendor Change Process: Types of File Processes Certificates of training may be accepted by a qualified vendor organization. The certificate must include the vendor company logo, person’s name testing, name of training and date

completed. Company Policies are not acceptable without the confirmation of the DHP’s training along with their completion

dates. If self-employed, please provide actual certificate. Statement from DHP is not acceptable – Please visit

www.HIPAAExams.com to obtain training and certificate

Professional License or Certification o Reoccurrence: Upon expiration of the current Professional License or Certification

Verify with eDHP, Division Specific Scope of Service Form, and/or Job Description –you submit any professional licenses or certifications required for the Classification.

BLS (Basic Life Support) – Healthcare Provider Card

o Reoccurrence: Upon expiration of the Card (every 2 years) The only acceptable card is from the American Heart Association or The Red Cross. The Physical card must have the DHP’s name, signature and an expiration date Must submit copies of the front and the back of the card. (back of card provides instructor/location) AHA eCards are acceptable. Must be the entire eCard, no cut offs.

o Do not send the link to your credentialing specialist. o Save the card down to a PDF or JPG or a screen shot saved.

The Roster is acceptable for 30 days as long as it has the Instructors Name, Instructors Signature that the DHP completed the course, the DHPs name on the roster along with DHPs signature and the completed date of the course.

Healthcare Provider Card is different training than the AHA CPR Card (for anyone who wants to be certified, not necessarily healthcare providers)

AHA has recently (2/2016) changed the title of the card from “BLS Healthcare Provider” to “BLS Provider”.

https://staffrx.app.medcity.net/StaffDHP.Net/Documents/pdf/CREDENTIALING/OR%20Protocol%20Attestation%20form.pdf

http://www.hipaaexams.com/

http://www.hipaaexams.com/



Certificate of Insurance (Back to Index) o Proof of General Coverage Liability, Product or Professional liability coverage for the DHP. Please refer to the Certificate

of Insurance Guidelines available here o Reoccurrence: Upon expiration of the COI

Examples of 3rd Party Individuals verbiage: Insurance covers all Distributors and Independent Representatives. Umbrella Liability Coverage verbiage must state the policy/coverage it applies to. Medical Malpractice is Professional Liability on some policies. If this is seen, we need the DHPs name on the policy

stating they are covered. Cannot be nickname, needs to be legal name. Binder & Applications in place of actual COI are not acceptable.

Coverage Limits Verbiage

General Liability Coverage Limits (GCL) ALWAYS NEEDED WITH PRODUCT

1,000,000 each occurrence / 3,000,000 aggregate

No verbiage required

Product Liability 1,000,000 each occurrence / 3,000,000

aggregate Must include verbiage only if the DHP is a Distributor or Independent Rep.

Professional Liability Depends on the State Must include verbiage

STATE

Professional (Each Occ/Agg)

AK $1 million/$3 million CA $1 million/$3 million CO $1 million/$3 million FL $250k/$750k GA $1 million/$3 million ID $1 million/$3 million IN $1 million/$3 million KS $200/$600k KY $1 million/$3 million LA $100k/$300k

MO $1 million/$3 million MS $1 million/$3 million NC $1 million/$3 million NH $1 million/$3 million NV $1 million/$3 million OK $1 million/$3 million SC $1 million/$3 million TN $1 million/$3 million TX $200k/$600k UT $1 million/$3 million VA $2 million/$6 million

https://staffrx.app.medcity.net/StaffDHP.Net/Documents/pdf/GENERAL/Certificate_of_Insurance_Guidelines.pdf



Background Report Requirements (Back to Index) Individual Background Check Results

o Reoccurrence: Once upon initial application, unless an attestation was originally submitted. o Background reports must contain all of the elements listed below. o Background reports must have the Social Security Numbers redacted. o If Background reports include Credit Report Results or Salary Information, this section must be redacted. If there is a Summary Document from the background company with the results, it may be sufficient to satisfy this

credential. This would need to be reviewed and approved by DHP HealthTrust management.

Tier Background Check Compliance Sub-Requirements 2,3 Verification Of Previous Employment History

The Company may submit a letter on

letterhead, signed & dated by an HR Representative that certifies the company has an internal process that confirms 7 years of previous employment history and there were no outstanding issues.

The letter must be approved by DHP HealthTrust’s Management.

Does not indicate unsatisfactory performance Employment History is up to 7 years Gaps in employment more than one month(send

out Employment Gap Acknowledgement Form) *If tenured past 7 years with current employer, data may

not have been retained due to retention policies, etc. Missing data will be considered exceptions and will

require DHP management approval. PWS Credentialing Specialists will route request to internal Mgmt. for approval to accept.

Management will need to verify with hiring company.

1,2,3 Criminal Search 7 year search or 5 counties documented If there are convictions, PWS must be made aware

of the details No pending cases

2,3 (clinical or if on SOS)

Education Verification Confirmation of highest level of education attained and must be on the background check result. Transcripts and diplomas are not acceptable form of proof.

2,3 Does not reveal any disciplinary actions/exclusions

If there are disciplinary actions/revocations/ suspensions, PWS must be made aware of the

1,2,3 Social Security number verification SSN Verification

1,2,3 GSA/OIG/SAM State-level Exclusions

Confirmation that the individual is not any lists to include State-level Exclusions or for any License E l i

1,2,3 Sex Offender Registry (SOR) Confirmation that the individual is not the list 1,2,3 OFAC/SDN Confirmation that the individual is not the SDN list

Self Employed DHPs may submit proof of business ownership through primary source verification in order to complete the

Employment History & Current Employment Verification elements of the background. This includes, but is not limited to, submitting 1099s or W9s for every year (financial information redacted) or verification from a state website (i.e. Sunbiz).

Background Check Provider Option DHP HealthTrust has negotiated pricing with a vendor who provides background checks and are aware of the HCA

requirements. Evolution Consulting Products and Pricing select this link: Click here for pricing and options

Click Here to Setup Acct Background Check and Drug Screen Provider

https://www.evoconreceive.com/Parallon/DHP/Parallon_Guide.pdf

https://www.evoconreceive.com/Parallon/DHP/ParallonDHP1.php



Mississippi State Requirement: (Tier 2 and 3 only) o Reoccurrence: Once upon initial application o This is required for access to Garden Park Medical Center. o It is a criminal history record check by the Mississippi State Department of Health

o Fingerprint clearance letter must be submitted; letter must be current within the last 2 years o Letter must be notarized & signed o The Fingerprint clearance letter can be done at any facility in the state of Mississippi. Preference is Garden Park.

Missouri State Requirement: (All Tiers)

The MO Highway State Patrol Check is a statewide criminal search of the Central Repository performed by the MO Highway State Patrol. All law enforcement agencies, prosecutors, courts, and the Department of Corrections are required to submit certain information related to all felony and aggravated misdemeanor arrests, including all alcohol and drug related traffic offenses.

Reoccurrence: Once upon initial application

The MO EDL is a requirement with regards to Facility-Based screenings for DHP HealthTrust. Facilities located in states which maintain a state exclusion list must search the state exclusion list on a monthly basis to ensure that no employee is an ineligible person. However, we have opted for this credential to be a quarterly MO EDL screening to ease the credentialing process. A requirement of DHP HealthTrust is to compare its independent contractors, employees of staffing agencies or contracted service entities, as appropriate, to the GSA, OIG lists and the (14) state exclusion lists.

Reoccurrence: Upon expiration (every 3 months) Use Chrome to access this link for the MO EDL Form https://staffrx.app.medcity.net/StaffDHP.Net/Documents/pdf/GENERAL/MO%20EDL%20Form.pdf

o MO Highway State Patrol Check

If the Background Report includes a Nationwide Search or Statewide Search, the details of report must show the state of Missouri was included. If it does, the MO Highway State Patrol Check is contained within the search.

If the Background Report does not include a Nationwide Search or Statewide Search that shows the state of Missouri was included in then the MO Highway State Patrol Check must be completed.

County searches are not acceptable for the MO Highway State Patrol Check.

o MO Employee Disqualification List (MO EDL) –Please contact DHP HealthTrust in order to be sent the MO EDL Form.

The form must be completed & sent to the MO State Highway Patrol Criminal Justice Information Services Division in order for the search to be completed.

Upload the completed search results to your eDHP account.

This is required for access to the following facilities: Belton Regional Medical Center Lafayette Regional Health Center Centerpoint Medical Center Lee’s Summit Medical Center Centerpoint Hospitalist Research Medical Center Centerpoint Ambulatory Surgery Center Research Psychiatric Center

Alaska State Requirement:

o This is required for a Proximity Badge at Alaska Regional Medical Center & Surgery Center of Anchorage. o Reoccurrence: Once upon initial application, unless undergoing the Vendor Change Process: Types of File Processes o This applies to anyone taking care of patients, or who have access to the hospital or to patients (outside of what the

general public would have), or anyone who has access to funds all have to go through State of Alaska. Sales Reps do not. However, there are some sales reps who want a proximity badge and the proximity badge allows them to access areas that the general public would not typically access. Depends on DHPs classification and/or if they need escorted or unescorted access to the hospital. Alaska Regional Hospital informs the DHP HealthTrust Team Lead (Mountain Division) via email to inform the DHP

whether or not the Alaska Background is needed.

https://staffrx.app.medcity.net/StaffDHP.Net/Documents/pdf/GENERAL/MO%20EDL%20Form.pdf



If needed, the DHP must submit the completed Employment Authorization Form from the State Background Check (All Tiers)

Nevada State Requirement: o This is a State Statue for the Government not an HCA requirement. o Reoccurrence: Once upon initial application o Background checks and fingerprinting through Nevada Records of Criminal History is required of all DHPs regardless of the

Line of Business.

How to Complete the Additional Background Requirements: Missouri (Back to Index)

Complete Block I

Complete Section A & select Box 3.

Complete Section B:

The Requestor Information can be filled out by the delegate or the DHP to complete.

Complete Block II

Complete Sections C & D. Even though there is a comment about a notary on Section D, you DO NOT need a notary. The form is just not correct. We have verified this.

DO NOT COMPLETE SECTION E (Notary Information)

Complete Block III

Mail Document to address on page 2 or send via fax to 573-522-8463. See highlight on this page below.

MO State Highway Patrol will send back to the Requestor an approved & stamped document.

This should be uploaded to DHPs account, after the Social Security Number is redacted. You may leave the last 4 digits.



How to Complete the Additional Background Requirements: Alaska (Back to Index)

Be advised that the Provider ID/Password is company specific (not employee/DHP Specific) and only your company will have this information. DHP HealthTrust does not have access to this information and is therefore unable to provide it to you. Reach out to your company for the processing of your Alaska Background Check including access to the Provider ID/Password. Contact your Company to obtain/issue a Provider ID Number from the State of Alaska Background Check Program. Provider ID Number and password are specifically linked to each individual Company. Read and fill out the Employment Agency Section. When completed, fax the agreement to the State of Alaska Background Program @ 907-269- 3488. If you have any questions, please call Director of Human Resources Alaska Regional Hospital (907) 264-1777. Do not reach out to DHP HealthTrust to obtain the Provider ID/Password



Health Requirements (Back to Index) Immunizations do not require a signature. However, DHP HealthTrust must receive an official record from one of the following:

• Health clinic or practice • State repository • Vendor vaccination company (From Current Employer) • Occupational health

This does not mean a receipt from a pharmacy or a “doctored” document where the contact info/address has been handwritten, or a childhood booklet (like a passport). If it is suspect or looks doctored, then DHP HealthTrust reserves the right to require that a signature be obtained. Please redact the full social security number. Documents that are not redacted will be returned to the DHP. What should be on the official record (combination):

• Company Name or Logo (which must include the company name) and/or address information: Clinic/repository/company/vendor vaccination /state repository located clearly on the document

• Patient Name & secondary identifier (only if the DHP has a common name): i.e., date of birth or address (this may be handwritten; it is needed to verify the correct DHP in eDHP)

• Immunization Details: Description, Result, Series (if applicable), Date Performed, Date Read Records Given Outside of the U.S.: Based on the CDC Standards, all immunizations given outside of the U.S. must be reviewed by a current practicing Physician in the U.S. to determine if the immunizations meet the US CDC Standards.

• This process needs to be documented by the Physician & stated that all immunizations were reviewed & meet the current US Government CDC Standards.

TB Test / PPD

o Other names for PPD = TB; Quantiferon TB Gold (titer); Mantoux Test; Pirquet Test o Reoccurrence: Annual

Test results must be current within the last year The standard is: results must clearly state the administered & read dates. Any deviations must be approved by

Management. Date read must be within 48-72 hours of test administered

If unable to follow up in the 48-72 hr. period after skin test administration, a newer test, based on blood serum offers alternatives to the indeterminate status no matter the reason. The test is an IGRA or T-Spot offered by the hospital or reference labs.

South Atlantic Division - South Carolina Hospitals (Colleton MC, Grand Strand Regional MC, Trident MC): TB test upon initial credentialing must be dated within 90 days of application submitted date. (All Tiers)

Reading of 0-9 is negative, anything 10 and higher is positive, unless stated otherwise on the results by the physician/clinician.

If in letter format, it must be on letterhead. If DHP has positive history of PPD/TB – then one chest x-ray must be submitted along with a TB Questionnaire.

Only the TB Questionnaire must be updated annually - form available here. San Antonio Division – Tier 1: Negative TB Skin Test or Tspot & Questionnaire (no chest xray) and Tier 2/3 Negative TB

Skin Test or Tspot & Questionnaire (no chest xray)

Fit Test – San Antonio only - N-95 (Aurora 1870+) Respiratory Mask Fit testing If declining the only acceptable reasons are a medical condition or facial hair that prevents the mask from fitting

properly Flu Vaccination Information

o Reoccurrence: Only during flu season If declining must submit DHP HealthTrust’ s declination form; forms only available at the start of each season If declining, the reason must be selected. Flu receipts can only be accepted if it contains DHP’s name, administered date, clearly states Flu was given.

https://staffrx.app.medcity.net/StaffDHP.Net/Documents/pdf/HEALTH/TB_Questionnaire.pdf



Health Requirements – con’t

Varicella Documentation

o Proof of two vaccinations or positive titer results o Reoccurrence: Once upon initial application

History of childhood illness is not considered proof of immunity in TEXAS ONLY Booster shots or a Titer can be provided; results must be positive Equivocal results are not considered immune San Antonio Division - Varicella must follow vaccine schedule (Titers acceptable)

MMR Documentation

o Proof of immunity for Measles (Rubeola), Mumps and Rubella o Reoccurrence: Once upon initial application

Proof of immunizations, an actual lab report documenting proof of immunizations, or the blood draw from a titer test to document immunity.

Equivocal results are not considered immune. Must be 1 or 2 doses when providing vaccine records (Midwest Division requires proof of 2 doses) Regardless of the CDC Guidelines, if the DHP is born before 1957 they must submit proof of immunity for Mumps

(MMR). San Antonio Division - MMR must follow vaccine schedule (Titers acceptable)

Hepatitis B Documentation

o Proof of three vaccinations series o Reoccurrence: Once upon initial application Titer results can be provided and must be positive Equivocal results are not considered immune Twinrix (Combination of HEP A & B) and Recombivax are forms of the Hep B Vaccination If declining must submit DHP HealthTrust’ s declination form; Declination Form available here San Antonio Division – Hep B must follow vaccine schedule 0, 3, 6 months (no gaps) or DHP will be considered non-

compliant (Titers acceptable)

Tdap Documentation o Proof of vaccination for Tetanus, Diphtheria, & Acellular Pertussis o Reoccurrence: Once every 10 years from the administered date (unless a titer is submitted)

Declination Form available here – must select appropriate Division Tdap cannot be declined if requesting access to Maternity & Nursey areas in the hospital Vaccination records for Td or Dtap are not acceptable Adacell and Boostrix are forms of the Tdap Vaccination TDAP titer does not expire

Drug Screen

o Attestation of satisfactory completion of pre-employment drug screen test or actual lab results are acceptable. o Reoccurrence: Once upon initial application, unless undergoing the Vendor Change Process: Types of File Processes

Panels are not required. Substances screened must include amphetamines, barbiturates, benzodiazepines, opiates, marijuana, methadone and cocaine.

Documents must have the Social Security Numbers redacted; the last 4 digits are acceptable. DHP HealthTrust also provides an Attestation of Satisfactory Drug Screen Requirements form that can be

completed by the DHP’s employer – form available here If using the DHP HealthTrust Attestation, all sections of the form must be completed. San Antonio Division – must be performed within 30 days of submitting account for credentialing review

https://staffrx.app.medcity.net/StaffDHP.Net/Documents/pdf/HEALTH/Hepatitis_B_Declination_Form.pdf

https://staffrx.app.medcity.net/StaffDHP.Net/Documents/vaccine.html

https://staffrx.app.medcity.net/StaffDHP.Net/Documents/pdf/HEALTH/Attestation%20of%20Satisfactory%20Drug%20Screen%20Test%20Results.pdf



Payments (Back to Index) PayPal

• By default PayPal is the process to pay for membership in a DHP’s account via the eDHP system. Checks

• Personal Checks are not accepted • Company checks

o Made payable to DHP HealthTrust Workforce Management Solutions: PO BOX 742696 Atlanta, GA 30349

System & Process Information (Back to Index)

Statuses of Profiles • Not Submitted

o When a DHP is still working on uploading the required documents to the profile, attesting to the online credentials, and making the payment.

o In order to be assigned to a Credentialing Specialist, the entire profile must be submitted. • Submitted

o When the DHP has submitted all of the required credentials to the profile and has submitted the profile. o In this status, the profile is assigned to be reviewed by a Credentialing Specialist.

• Incomplete o When he Credentialing Specialist has reviewed the documents uploaded to the profile and have reached out to the

DHP via email in regards to the missing or unacceptable documents. • Completed

o When the Credentialing Specialist has reviewed and received all of the required documents to complete the profile. o The facilities selected in the profile are now able to review and either approve or deny the profile.

• Ready to Work o When the DHP’s profile has been reviewed and approved by at least one facility.

• Compliance o When the DHP’s profile has all of the required valid credentials met by the DHP.

• Non-Compliance o When there is one or more credentials missing or expired in the DHP’s profile.

• Suspended o Applies to Profiles in Process: The status a DHP is placed in when the credentialing specialist has not received all of the

correct credentials required/requested within the 30 day timeframe. The eDHP account is still active, yet the credentialing specialist is not actively working the profile until the

corrected credentials are submitted via eDHP. In this status, weekly reminders are not sent out. It is up to the DHP to contact the credentialing specialist for

the remaining credentials and/or to complete the credentialing process. • Deactivation

o Applies to Completed Profiles: The status a DHP is placed in when they have had a credential expired for over 90 days. The eDHP account is not active. The DHP will have to call the Customer Service Department in order for the account to be activated, email

address confirmed and if necessary, the password to be reset. Once the account is activated, the DHP has 48 hours to log-in their eDHP account to avoid the profile being

automatically suspended.



Types of File Processes (Back to Index)

Initial Process: o A file that is brand new to the Credentialing Process.

The DHP may not access HCA facilities during the Initial Process.

o Documents Required: Based on the Classification, Tier & Division of the DHP. Refer to TIER CORE REQUIREMENTS

Annual Process:

o Annual process to update the credentials that have expired or are within 90 days of expiring. The DHP may not access HCA facilities during the Ongoing Process if they have credentials which have

expired.

o Documents Required: Scope of Service (if an outdated version is on file) Job Description (if there not one on file) Background Report (if there is an Attestation on File; Hire Date Letter is required if not already on file) Competency/Skills Checklist

Additional documents may be requested if they have expired or do not meet our current requirements.

Added Division Process:

o When a DHP requests access to one or more divisions other than the Division they were originally credentialed for. The profile needs to be reviewed to confirm whether or not the DHP is compliant for the requirements to

the added division. The DHP may not access HCA facilities within the added division until the Added Division Process is

completed. The DHP may access the HCA facilities in the other Division they are already credentialed for.

o Documents Required:

Scope of Service Vaccines are dependent on the Division

Vendor Change Process:

o When a DHP changes companies, we are required to collect certain documentation reflecting the change in employers.

The DHP may not access HCA facilities until the Vendor Change Process is completed.

o Documents Required: Letter of Compliance Competencies/Skills Checklist (Clinical DHPs only) Scope of Service Job Description Certificate of Insurance

If an attestation from the previous employer is on file for these items, updated documents will be required: (Third

party continuing education certificates are acceptable). Proof of HIPAA Training Proof of OR Protocol Training Background Report Drug Screen Report or Attestation

Additional documents may be requested if they have expired or do not meet our current requirements.



Contact Information for DHP HealthTrust (Back to Index) If you have any questions about the application process, please do not hesitate to call or email us. Operating hours 7 am to 6 pm To locate various documents needed to credential, please select this link: eDHP Extranet - Document Location Customer Service Local: 954-514-1440 Toll Free: (800) 737-8661 ext. 1440 Fax (secure e-fax): (866) 361-2812 eDHP Email Address: [email protected] Main Email Address: [email protected]

Physical Address 1000 Sawgrass Corporate Pkwy 6th Fl Sunrise, FL 33323

PLEASE NOTE THAT DOCUMENTS SHOULD NOT BE EMAILED TO CUSTOMER SERVICE TO UPLOAD. ANY RECEIVED WILL BE DELETED AND THE DHP WILL BE NOTIFIED. Michele Roellig Vice President, Credentialing P: 954.514.1469 [email protected]

Geness LeBron Manager, DHP Credentialing P: 954.514.1548 [email protected]

Terri Leyva Director, DHP Implementations P: 954.514.1435 [email protected]

Phyona Scarlett Manager, DHP Credentialing P: 954.514.1478 [email protected]

Divisions: Gulf Coast, Central, West Texas & North Texas Eli Johnson DHP Credentialing Team Lead P: 954-514-1269 [email protected]

Divisions: Continental, Far West & Mountain Diana Velazco-Nunez DHP Credentialing Team Lead P: 954-514-1443 [email protected]

Divisions: All Florida & South Atlantic Elizabeth Rudd DHP Credentialing Team Lead P: 954-514-1429 [email protected]

Divisions: Capital, MidAmerica & TriStar Erica Allen-Baker DHP Credentialing Team Lead P: 954-514-1406 [email protected]


mailto:[email protected]








