DRAFT- Credentialing and Privileging_RTM.xlsx
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- Solicitation number
- 36C10B26Q0275
About this file
This is a Business Requirements Package (BRP) and Requirements Traceability Matrix (RTM) for the VA's Credentialing and Privileging System Modernization (NSR 20251210), scheduled for March 2026 implementation. The document details 255 business requirements across multiple functional workflow areas including practitioner enrollment, credentialing application management, credential verification, governance review processes, focused professional practice evaluation (FPPE), ongoing professional practice evaluation (OPPE), temporary credentialing, file transfers, exit reviews, and core system functionality. Key requirements address electronic application submission with pre-population of practitioner data, automated duplicate detection, primary source verification (PSV) of licenses and certifications, national databank queries (NPDB), professional reference verification, document management with categorization and extraction capabilities, role-based dashboards and notifications, automated routing through service chief and chief medical officer (CMO) review stages, privileging determinations by medical directors, and continuous credential monitoring with expiration alerts.
The solution must support both Licensed Independent Practitioners (LIPs) requiring credentialing and privileging and Non-LIPs requiring credentialing only, with differentiated workflows based on occupational categories. Advanced features include automated FPPE plan generation with national and facility-specific clinical indicators, performance data ingestion from the Federal EHR (CPT claims, laboratory results, mortality/outcome reports, chart reviews, peer feedback), OPPE cycle management, privilege modifications based on evaluation outcomes, and administrative functions such as shared access between facilities, file transfers, practitioner exit processing, and file reactivation. The system requires integration with HR platforms for personnel coordination, compliance with VA Handbook 6500 security requirements, 99.9 percent availability for production systems, and support for off-hours maintenance. Non-functional requirements include searchable help content, guided tutorials, report generation and sharing, enterprise and user-level access permission configuration, secure data storage, and comprehensive audit logging across all modules.
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| 36C10B26Q0275_2.docx | DOCX document | |
| VA Responses to Industry Questions- 36C10B26Q0275 RFI.xlsx | XLSX spreadsheet | |
| 36C10B26Q0275_1.docx | DOCX document | |
| 36C10B26Q0275.docx | DOCX document |
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Cover
| Department of Veterans Affairs | |
| PRE-DECISIONAL | |
| Business Requirements Package |
| NSR 20251210 |
| Credentialing and Privileging System Modernization |
March 2026
RTM
NSR Name and ID: 20251210-Credentialing and Privileging System Modernization
| Request ID | Category | Business Requirement | Business Acceptance Criteria | Business Rules | Detailed Explanations | Business Non-Functional Requirements | Priority | Mapping to Process Models | Supporting VA Directive, Policy, Law | BoundField | Abbrev |
| 20251210 | Manage Practitioner Credentialing and Privileging | As a Credentialing and Privileging (C&P) Specialist, I need to generate an electronic credentialing application in the C&P solution, so that I can begin the credentialing process electronically. | The specialist can create a provider file if none exists. |
The C&P Specialist can generate an electronic credentialing application from within the C&P solution.
| The system shall pre-populate the generated application using available practitioner data already stored in the solution. | Initiating the credentialing process electronically centers on creating or locating the practitioner’s provider file, generating the correct application package, and inviting the practitioner to complete required forms in a secure, role‑aware experience. The solution distinguishes Licensed Independent Practitioner (LIP) from Non-Licensed Independent Practitioner (Non‑LIP) to include privileging setup only when appropriate, enforces critical prerequisites such as an e‑signed Release of Information (ROI), and pre‑lists required documents to streamline completion. Automated invitations, Service Level Agreement (SLA) tracking, and dashboard visibility improve throughput, while duplicate detection, strong access controls, and comprehensive audit logging safeguard accuracy, privacy, and compliance. Accessibility support and defined performance thresholds ensure the workflow is responsive and usable for all stakeholders. | 1 | WRKFS0000105CUA-Manage Practitioner Credentialing and Privileging-2291266-Search For Provider Files | BR | ||||||
| 20251210 | Manage Practitioner Credentialing and Privileging | The system shall perform a duplicate practitioner record match check at the point of credentialing enrollment in the C&P solution. | Duplicate practitioner records create downstream rework, fragmented verification history, and misaligned credentialing/privileging decisions. Performing a duplicate- aware search automatically at the point of enrollment helps prevent duplicates before they are created by identifying existing records that may match the practitioner being enrolled. | 2 | WRKFS0000105CUA-Manage Practitioner Credentialing and Privileging-2291266-Search For Provider Files | BR | ||||
| 20251210 | Manage Practitioner Credentialing and Privileging | As a C&P Specialist, I need to view possible duplicate practitioner matches in the C&P solution at the point of enrollment, so that I can avoid creating a duplicate practitioner record. | The C&P Specialist can view key comparison details for each possible match such as: |
- Practitioner name
- Date of birth
- NPI if applicable
- License number(s) if applicable
| Even when the system performs an automated duplicate check, the C&P Specialist needs visibility to confirm whether the enrollment corresponds to an existing practitioner record or represents a new individual. Presenting possible duplicate matches at the point of enrollment supports accurate identity reconciliation and reduces the chance of creating redundant records that split credential history, verification outcomes, and privileging decisions across multiple profiles. | 3 | WRKFS0000105CUA-Manage Practitioner Credentialing and Privileging-2291266-Search For Provider Files | BR | ||
| 20251210 | Manage Practitioner Credentialing and Privileging | As a C&P Specialist, I need to search for an existing practitioner using duplicate-aware matching in the C&P solution, so that I can avoid creating duplicate provider records. | The C&P Specialist can search for provider files in the C&P solution using identifying attributes such as: |
- SSN
- Legal name
- Occupation
- Facility
- Date of birth
- Primary address
- Phone number
The system shall display potential matches.
| The system shall indicate when no results are found. | Practitioner files are foundational records used across C&P workflows and duplicate files can create downstream issues such as fragmented credential histories, inconsistent verification status, and duplicated work across applications. A duplicate-aware search helps the C&P Specialist locate an existing provider file even when identifying information is incomplete or entered with minor variations. Presenting potential matches supports quick confirmation and reduces the risk of unintentionally creating a duplicate record. | 4 | WRKFS0000105CUA-Manage Practitioner Credentialing and Privileging-2291266-Search For Provider Files | BR | ||
| 20251210 | Manage Practitioner Credentialing and Privileging | As a C&P Specialist, I need to create a practitioner file in the C&P solution when automation fails, so that I can ensure the practitioner's information is available for downstream C&P activities. | The C&P Specialist can enter all mandatory fields such as: |
- SSN
- Legal Name
- Occupation
- Facility
- Date of birth
- Primary address
- Phone number
The system shall prevent submission until all required fields are complete.
The system shall perform duplicate detection.
The system shall assign a unique identifier to the provider file. Creating a provider file is the foundational step in the credentialing and privileging process because it establishes a single, authoritative record for each practitioner. This record serves as the anchor for all subsequent activities, including generating the credentialing application, initiating verification workflows, and managing privileges. Without a properly structured provider file, downstream processes become fragmented, leading to duplicate records, incorrect data entry, and compliance risks.
| The practitioner file should be created by the system at the point of enrollment. This story covers the need for a C&P Specialist to be able to create this file if the system fails to generate the file at the point of enrollment. | 5 | WRKFS0000105CUA-Manage Practitioner Credentialing and Privileging-2291266-Search For Provider Files | BR | ||
| 20251210 | Manage Practitioner Credentialing and Privileging | The system shall create a practitioner file when a practitioner is enrolled and the required baseline data elements are present in the C&P solution. | The system shall auto-create the provider file when enrollment data contains all required fields such as: |
- SSN
- Legal Name
- Occupation
- Facility
- Date of birth
- Primary address
- Phone number
The system shall perform duplicate detection.
| The system shall assign a unique identifier to the provider file. | Creating a provider file is the foundational step in the credentialing and privileging process because it establishes a single, authoritative record for each practitioner. This record serves as the anchor for all subsequent activities, including generating the credentialing application, initiating verification workflows, and managing privileges. Without a properly structured provider file, downstream processes become fragmented, leading to duplicate records, incorrect data entry, and compliance risks. | 6 | WRKFS0000105CUA-Manage Practitioner Credentialing and Privileging-2291272-Create Provider File | BR | ||
| 20251210 | Manage Practitioner Credentialing and Privileging | As a C&P Specialist, I need to select the occupational category during enrollment in the C&P solution, so that I can ensure the practitioner is enrolled under the correct C&P workflow. | The C&P Specialist can select the occupational category during enrollment including: |
• Category 1 o LIP Practitioners
• Category 2 o Non-LIP Practitioners
• Category 3 o Non-LIP Practitioners
• Category 4
| o Non-LIP Practitioners | Enrollment is the point where the practitioner is first established in the C&P solution and placed onto the appropriate processing path. The occupational categories represent how the practitioner is classified for credentialing and privileging purposes: Category 1 - LIP, Category 2 - Occupations requiring education and licensure, Category 3 - Occupations requiring registration/certification, and Category 4 - other healthcare occupations. In this model Categories 2-4 are treated as Non-LIP. | 7 | WRKFS0000105CUA-Manage Practitioner Credentialing and Privileging-2291275-Enroll Practitioner | BR | ||||||
| 20251210 | Manage Practitioner Credentialing and Privileging | The system shall determine the practitioner's C&P requirements based on their classification and enrollment attributes. | Determining whether a practitioner requires credentialing, privileging or both is a critical step for compliance and operational efficiency and it should be driven by the practitioner's enrollment classification and attributes captured at the point the practitioner is established in the C&P solution. Occupational categories have distinct governance requirements: Category 1 - LIP, Category 2 - Occupations requiring education and licensure, Category 3 - Occupations requiring registration/certification, and Category 4 - other healthcare occupations. In this model Categories 2-4 are treated as Non-LIP. | 8 | WRKFS0000105CUA-Manage Practitioner Credentialing and Privileging-2291305-Determine Credentialing and/or Privileging Need | BR | ||||
| 20251210 | Manage Practitioner Credentialing and Privileging | The system shall route a practitioner's file to the designated workflow based on file attributes. | Routing files based on their attributes ensures that each practitioner follows the correct governance path for credentialing and privileging. This eliminates manual triage, reduces errors, and accelerates processing by automatically directing applications to the right reviewers and committees. Using predefined rules tied to classification, employment type, and special indicators creates consistency and compliance across the enterprise. Automated routing also supports scalability and transparency by providing clear rule application and auditability, while minimizing delays caused by human intervention. | 9 | WRKFS0000105CUA-Manage Practitioner Credentialing and Privileging-2291305-Determine Credentialing and/or Privileging Need | BR | ||||
| 20251210 | Manage Practitioner Credentialing and Privileging | The system shall generate a pre-populated electronic credentialing application for a practitioner using existing practitioner file data and enrollment attributes in the C&P solution. | Generating the electronic application from existing provider data ensures accuracy, consistency, and speed at the outset of processing. Pre‑population reduces manual entry errors and accelerates completion, while packaging required artifacts (such as ROI) enforces authorization and compliance. Automatic invitations and status updates create transparency for both practitioners and staff, and completeness checks prevent premature routing. | 10 | WRKFS0000105CUA-Manage Practitioner Credentialing and Privileging-2291286-Generate Privileging Application | BR | ||||
| 20251210 | Manage Practitioner Credentialing and Privileging | The system shall send the credentialing/privileging application package to the practitioner from within the system using system-managed templates and delivery channels. | Sending application packages from within the credentialing solution standardizes communication, reduces manual hand‑offs, and ensures consistent, compliant outreach to practitioners. System‑generated invitations, status updates, and audit trails provide transparency and traceability, while template‑driven content and routing align the package to the practitioner’s classification and facility. Centralizing dispatch eliminates variability across sites, accelerates onboarding, and supports downstream automation by reflecting package availability in status dashboards. |
| The system should determine credentialing only for Non-LIP and Credentialing and Privileging for LIP. | 11 | WRKFS0000105CUA-Manage Practitioner Credentialing and Privileging-2291276-Send Package | BR | ||
| 20251210 | Manage Practitioner Credentialing and Privileging | As an LIP or Non-LIP, I need to complete my credentialing application electronically within the C&P solution, so that I can submit all required information in one place. | The LIP or Non-LIP can update pre-populated credentialing fields and enter additional required details. |
The LIP or Non-LIP can save progress and resume later.
| Practitioners need a streamlined, electronic process to complete credentialing and privileging applications without manual paperwork or fragmented communication. Providing pre-populated data reduces errors and saves time, while electronic signatures and document upload capabilities ensure compliance. Real-time completeness checks and progress indicators improve transparency and reduce delays. This functionality supports both LIP and Non-LIP workflows and aligns with future-state goals for automation and practitioner self-service. | 12 | WRKFS0000105CUA-Manage Practitioner Credentialing and Privileging-2291277-Complete Application | BR | ||
| 20251210 | Manage Practitioner Credentialing and Privileging | As an LIP, I need to input my privileging application electronically within the C&P solution, so that I can submit all required information in one place. | The LIP can update pre-populated privileging fields and enter additional required details. |
The LIP can save progress and resume later.
| Practitioners need a streamlined, electronic process to complete credentialing and privileging applications without manual paperwork or fragmented communication. Providing pre-populated data reduces errors and saves time, while electronic signatures and document upload capabilities ensure compliance. Real-time completeness checks and progress indicators improve transparency and reduce delays. | 13 | WRKFS0000105CUA-Manage Practitioner Credentialing and Privileging-2291277-Complete Application | BR | ||
| 20251210 | Manage Practitioner Credentialing and Privileging | As an LIP or Non-LIP, I need to electronically sign my credentialing/privileging application within the C&P solution, so that I can complete submission of my application for processing. | The LIP or Non-LIP can apply an electronic signature to the application in compliance with VA policy and federal standards for e-signature. |
The system shall enforce a hard stop preventing submission until all required signatures are applied.
The LIP or Non-LIP can review signed documents before final submission.
| The system shall timestamp and store the signature in the LIP or Non-LIP's file. | Electronic signatures are critical for compliance and efficiency in credentialing and privileging workflows. They replace manual, paper-based processes and ensure that practitioners can authorize release of information and attest to application accuracy in a secure, auditable manner. Enforcing signature completion before submission prevents delays and compliance risks. Storing signed documents with timestamps provides transparency and supports regulatory requirements for recordkeeping. | 14 | WRKFS0000105CUA-Manage Practitioner Credentialing and Privileging-2291278-Sign Application | BR | ||
| 20251210 | Manage Practitioner Credentialing and Privileging | As an LIP or Non-LIP, I need to electronically sign the Release of Information (ROI) within the C&P solution, so that I can authorize C&P staff to verify my credentials. | The LIP or Non-LIP can view the ROI within the C&P solution. |
The LIP or Non-LIP can electronically sign the ROI within the C&P solution.
The system shall record the date/time the ROI was signed. The ROI is the authorization that permits C&P staff to request and obtain information from issuing authorities and other sources needed to verify a practitioner's credentials. Capturing the ROI electronically within the C&P solution reduces reliance on paper forms and manual tracking, ensures the authorization is tied to the correct practitioner and application, and creates a traceable record of consent. Recording signature metadata supports audit readiness and helps ensure verification activities proceed only after the required authorization is on file.
| If additional attestations are required in the future, they should be listed explicitly in the governing business rule and handled as separate signable items in this step. | 15 | WRKFS0000105CUA-Manage Practitioner Credentialing and Privileging-2291287-Sign and Submit Release of Information | BR | ||
| 20251210 | Manage Practitioner Credentialing and Privileging | As an LIP or Non-LIP, I need to submit my signed ROI electronically within the C&P solution, so that I can document my signed ROI in my practitioner file. | The LIP or Non-LIP can confirm submission of the signed ROI within the application workflow. |
The system shall display a confirmation message to indicate ROI submission is complete.
| The system shall store the submitted ROI in the LIP or Non-LIP's file with timestamp. | The ROI is a critical compliance artifact that authorizes credentialing staff and automated systems to collect and verify sensitive information. Making ROI completion mandatory before submission ensures legal authorization and prevents delays. Electronic signing eliminates paper-based workflows, supports remote completion, and provides a secure, auditable record. This step also acts as a trigger for subsequent automated verification processes, aligning with future-state goals for efficiency and compliance. | 16 | WRKFS0000105CUA-Manage Practitioner Credentialing and Privileging-2291287-Sign and Submit Release of Information | BR | ||||||
| 20251210 | Manage Practitioner Credentialing and Privileging | As a C&P Specialist, I need to upload documents to a practitioner document library in the C&P solution, so that I can maintain a complete application record in one location. | The practitioner document library will serve as the centralized location for documents associated with a practitioner in the C&P solution. While documents may be uploaded in the context of a specific workflow step, the library provides a consolidated view so that credentialing and privileging documents are not scattered across screens or stored outside the record. Clarifying that uploads may be associated either to the overall practitioner file or to a specific record or section helps ensure users understand how documents are organized while still maintaining a complete, traceable file. | 17 | WRKFS0000105CUA-Manage Practitioner Credentialing and Privileging-2291299-Upload Document(s) | BR | ||||
| 20251210 | Manage Practitioner Credentialing and Privileging | As a C&P Specialist, I need to assign a category to an uploaded document in the C&P solution, so that I can ensure required documents are identifiable for governance review. | The C&P Specialist can assign a category from a predefined list. | Document categories provide a consistent way to organize practitioner documents in the C&P solution so users can quickly locate the right supporting documentation during credentialing and privileging workflows. Assigning a category at upload improves usability by enabling grouping, filtering, and completeness visibility based on document type, rather than relying on ad hoc filenames or manual searching. Categorization also supports traceability and governance review by making it clear what kind of evidence has been provide, and it can enable downstream rules such as document requirement checks. | 18 | WRKFS0000105CUA-Manage Practitioner Credentialing and Privileging-2291299-Upload Document(s) | BR | |||
| 20251210 | Manage Practitioner Credentialing and Privileging | As a C&P Specialist, I need to filter practitioner documents in the C&P solution, so that I can quickly locate documents relevant to my current review task. | The C&P Specialist can apply more than one filter at a time. |
| As practitioner files grow over time, the document library can contain many artifacts across credentialing, privileging, and other related workflows. Filtering allows the C&P Specialist to narrow the library to the specific document types needed for the task at hand, reducing time spent scrolling or searching and minimizing the risk of overlooking required documentation. | 19 | WRKFS0000105CUA-Manage Practitioner Credentialing and Privileging-2291299-Upload Document(s)WRKFS0000105CUA.01-Verify Practitioner Credentials and Privileges-2291549-Attempt Primary Source Verification (PSV) | BR | ||||||
| 20251210 | Manage Practitioner Credentialing and Privileging | As a C&P Specialist, I need to link a document from the practitioner document library to an application section in the C&P solution, so that I can make supporting evidence available in the appropriate record context. | The system shall retain the document in the practitioner document library after it is linked to an application section or record. | The practitioner document library serves as the centralized repository for artifacts associated with a practitioner, while specific sections require direct access to the evidence that supports that portion of the record. Linking a library document to a application section allows the same document to be referenced in the appropriate workflow context without duplicating uploads or fragmenting the record across multiple copies. | 20 | WRKFS0000105CUA-Manage Practitioner Credentialing and Privileging-2291299-Upload Document(s) | BR | ||
| 20251210 | Manage Practitioner Credentialing and Privileging | As an LIP or Non-LIP, I need to upload my required supporting documents electronically within the C&P solution, so that I can complete my application without mailing or faxing copies. | The LIP or Non-LIP can upload required supporting documents directly into the application package. |
The system shall display a list of required documents based on LIP or Non-LIP type and facility-specific requirements.
The system shall confirm successful submission.
| The system shall store submitted documents in the LIP or Non-LIP's file with timestamp. | Submitting documents electronically ensures that practitioners can complete their application efficiently and securely without relying on manual processes. The system provides transparency through checklists and dashboard indicators, validates uploads for compliance, and maintains an auditable record of all submissions. This functionality supports both credentialing and privileging workflows and reduces delays caused by missing or misrouted documents. | 21 | WRKFS0000105CUA-Manage Practitioner Credentialing and Privileging-2291301-Submit Document(s) | BR | ||
| 20251210 | Manage Practitioner Credentialing and Privileging | As an LIP or Non-LIP, I need to submit my credentialing application in the C&P solution when all required sections are completed, so that I can initiate the credentialing review process. | The LIP or Non-LIP can submit the credentialing application only after all required items are completed. |
The system shall enforce a hard stop preventing submission if any required elements are missing.
The system shall display a confirmation message to indicate successful submission.
| The system shall timestamp the submission in the LIP or Non-LIP's file. | Practitioners need to submit their credentialing application electronically, eliminating manual processes such as mailing or faxing forms. This solution aims to empower practitioners to complete and submit their applications directly in the system, ensuring accuracy and reducing administrative burden. | 22 | WRKFS0000105CUA-Manage Practitioner Credentialing and Privileging-2291279-Submit Application | BR | ||
| 20251210 | Manage Practitioner Credentialing and Privileging | As an LIP, I need to |
submit my privileging application in the C&P solution when all required sections are completed, so that I can initiate the privileging process.
The LIP can submit the privileging application only after all required items are completed.
The system shall enforce a hard stop preventing submission if any required privileging elements are missing.
The system shall display a confirmation message to indicate successful submission.
| The system shall timestamp the submission in the LIP's file. | Licensed Independent Practitioners (LIPs) require privileging in addition to credentialing. The solution includes an electronic privileging application that practitioners can complete and submit within the same system as credentialing. | 23 | WRKFS0000105CUA-Manage Practitioner Credentialing and Privileging-2291279-Submit Application | BR | ||||||
| 20251210 | Manage Practitioner Credentialing and Privileging | The system shall validate a practitioner's credentialing application for completeness before allowing submission to downstream review. | This capability ensures applications enter review only when complete, using role‑aware rules that distinguish LIP from Non‑LIP and enforcing critical prerequisites such as the Release of Information. Automated validations span required fields, attachments, e‑signatures, and logical cross‑checks, while duplicate detection safeguards data integrity. When gaps are found, the system blocks progression, guides the user with a clear checklist, and preserves in‑progress work. Upon passing, applications are timestamped, logged for audit, surfaced on a status dashboard, and routed to the appropriate downstream workflow, reducing manual rework and accelerating end‑to‑end processing. | 24 | WRKFS0000105CUA-Manage Practitioner Credentialing and Privileging-2291295-Check For Application Completeness | BR | ||||
| 20251210 | Manage Practitioner Credentialing and Privileging | The system shall validate a practitioner's privileging application for completeness before allowing submission to downstream review. | This capability ensures applications enter review only when complete, using role‑aware rules and enforcing critical prerequisites such as the Release of Information. Automated validations span required fields, attachments, e‑signatures, and logical cross‑checks, while duplicate detection safeguards data integrity. When gaps are found, the system blocks progression, guides the user with a clear checklist, and preserves in‑progress work. Upon passing, applications are timestamped, logged for audit, surfaced on a status dashboard, and routed to the appropriate downstream workflow, reducing manual rework and accelerating end‑to‑end processing. | 25 | WRKFS0000105CUA-Manage Practitioner Credentialing and Privileging-2291295-Check For Application Completeness | BR | ||||
| 20251210 | Manage Practitioner Credentialing and Privileging | As a Practitioner, I need to receive a notification when an application fails the completeness check in the C&P solution, so that I can take steps to resolve any deficiencies. | The Practitioner can view an indicator when a completeness check returns "fail" for credentialing or privileging. |
| The Practitioner can view a concise summary of the failure and a completeness check that itemizes missing or invalid elements in the notification. | When an application fails validation, the system immediately informs the practitioner, distinguishes whether the issue is with credentialing or privileging, and provides a targeted checklist with direct links to fix each item. Notifications are delivered through configurable channels while protecting sensitive information, and the dashboard reflects status and progress in real time. Reminders and retry logic ensure the message is received, and all events are timestamped and auditable, enabling a clear path to remediation and minimizing back‑and‑forth with the credentialing office. | 26 | WRKFS0000105CUA-Manage Practitioner Credentialing and Privileging-2291297-Notify Applicant | BR | ||
| 20251210 | Manage Practitioner Credentialing and Privileging | As a C&P Specialist, I need to receive a notification in the C&P solution when a practitioner's C&P application fails the completeness check, so that I can promptly address missing information. | The system shall generate a specialist notification immediately upon a Fail result for completeness check. |
| The C&P Specialist can view the affected application type and service line in the notification. | When a practitioner submits an application, completeness checks help ensure required fields, documents, and attestations are present before the application moves into verification and downstream review. If an application fails the completeness check, C&P work can stall unless the issue is identified and addressed quickly. An in-solution notification to the assigned C&P Specialist provides timely awareness that the submission is complete, reduces reliance on manual monitoring and supports efficient application management. | 27 | WRKFS0000105CUA.01-Verify Practitioner Credentials and Privileges-2291528-Review System Dashboard For Completeness | BR | ||
| 20251210 | Manage Practitioner Credentialing and Privileging | As an LIP or Non-LIP, I need to update my C&P application in the C&P solution after receiving a notification of incompleteness, so that I can correct deficiencies and resubmit for review without restarting the entire process. | The LIP or Non-LIP can access the C&P application from their dashboard. |
The LIP or Non-LIP can view a completeness checklist showing all missing or invalid items.
The LIP or Non-LIP can navigate directly to incomplete sections.
| The system shall re-run completeness checks after updates are made. | This capability ensures practitioners can efficiently correct incomplete applications without restarting the process. The system provides a clear checklist of deficiencies, targeted navigation, and real-time validation to reduce errors. Updates include document uploads and electronic signatures, with role-based logic for credentialing and privileging. Progress can be saved and resumed, and once all gaps are resolved, the system automatically revalidates and enables resubmission, streamlining the workflow and minimizing delays. | 28 | WRKFS0000105CUA-Manage Practitioner Credentialing and Privileging-2291298-Update ApplicationWRKFS0000105CUA.01-Verify Practitioner Credentials and Privileges-2291528-Review System Dashboard For Completeness | BR | ||
| 20251210 | Manage Practitioner Credentialing and Privileging | As a C&P Specialist, I need to receive a notification in the C&P solution when a practitioner's C&P application passes the completeness check, so that I can ensure complete applications are routed into downstream workflows. | The system shall detect when a practitioner's C&P application passes the completeness check. |
The C&P Specialist can view key details in the notification including:
- Application identifier
- Practitioner identifier
- Completeness check result
| - Date/time of the completeness check | Completeness checks are a control point that confirms required application information and supporting materials are present before credentialing work proceeds. When an application passes the completeness check, the C&P Specialist needs timely awareness so the application can move into the next workflow phase. An in-solution notification provides clear, traceable confirmation that the submission is ready for processing, reduces the need for manual monitoring, and creates an auditable record of when readiness was established and communicated to the assigned specialist. | 29 | WRKFS0000105CUA-Manage Practitioner Credentialing and Privileging-2291296-Send Notification To Credentialing and Privileging SpecialistWRKFS0000105CUA-Manage Practitioner Credentialing and Privileging-2291311-Send Notification To Credentialing and Privileging Specialist | BR | ||
| 20251210 | Manage Practitioner Credentialing and Privileging | As a C&P Specialist, I need to view privileging documents submitted by a practitioner in the C&P solution, so that I can ensure the requested privileges align with facility requirements. | The C&P Specialist can view the complete privileging application including: |
- Requested privileges
- Supporting documentation
- Electronic signatures
The C&P Specialist can view the practitioner's credentialing status and any dependencies alongside privileging details.
| The system shall highlight any discrepancies. | This capability ensures that privileging requests are thoroughly reviewed for accuracy, compliance, and alignment with facility capabilities before advancing in the approval workflow. The system provides visibility into the practitioner’s credentials, supporting documents, and requested privileges, while surfacing automated validation results and discrepancies. Managers can annotate recommendations, confirm completeness, and route the application to the next review stage, with all actions logged for audit and compliance. | 30 | WRKFS0000105CUA-Manage Practitioner Credentialing and Privileging-2291309-Review Privileging Documents | BR | ||
| 20251210 | Manage Practitioner Credentialing and Privileging | As an LIP, I need to view a system-generated notification in the C&P solution when my privileging status changes, so that I can understand my current status. | The system shall notify the LIP when privileges are modified. |
The LIP can view key details in the notification including:
- Status
- Timestamp of the change
- Effective appointment date
- A link to view full privileging details
| The system shall ensure notifications are visible immediately after status change events occurs. | This capability ensures that practitioners receive timely, clear, and secure updates about their privileging status directly within the solution. Notifications provide essential details such as approval status, effective dates, and privilege lists, reducing reliance on manual emails or phone calls. The feature supports transparency, compliance, and operational readiness by enabling practitioners to act quickly on any required steps and maintain visibility into their privileging history. | 31 | WRKFS0000105CUA-Manage Practitioner Credentialing and Privileging-2291288-Notify LIPWRKFS0000105CUA-Manage Practitioner Credentialing and Privileging-2291290-Notify Human Resources | BR | ||
| 20251210 | Manage Practitioner Credentialing and Privileging | As an Human Resources (HR) Team Member, I need to view a notification when a Non-LIP or LIP's credentialing status changes, so that I can update required actions based on the new status. | The HR Team Member can view key details in the credentialing status change notification such as: |
- Practitioner identifier
- Previous credentialing status (if applicable)
- New privileging status
- Effective date
| - Notification date/time | When a Practitioner's credentialing status changes, HR often needs timely awareness because status changes can drive downstream personnel actions, onboarding steps, access provisioning, start-date coordination, or other administrative activities that depend on the practitioner's eligibility state. Providing a notification to HR when the credentialing status changes helps ensure HR is working from the same authoritative record as C&P Specialists. | 32 | BR | ||
| 20251210 | Verify Practitioner Credentials and Privileges | As a C&P Specialist, I need to view a practitioner's completed credentialing application in the C&P solution, so that I can confirm the application is complete. | The C&P Specialist can view application identifiers including: |
- Application identifier
- Practitioner identifier
- Application status
| The C&P Specialist can view any supporting documentation attached to the application. | C&P Specialists need a complete, in-solution view of the credentialing application to understand what information has been submitted and what is available to support verification and downstream review. Viewing the full application including key identifiers, application status, entered data across relevant sections, and any supporting documentation, reduces reliance on external files or searching across multiple screens. | 33 | WRKFS0000105CUA.01-Verify Practitioner Credentials and Privileges-2291527-Review Credential InformationWRKFS0000105CUA.01-Verify Practitioner Credentials and Privileges-2291549-Attempt Primary Source Verification (PSV) | BR | ||
| 20251210 | Verify Practitioner Credentials and Privileges | As a C&P Specialist, I need to view a practitioner's completed privileging application in the C&P solution, so that I can confirm the supporting information needed for application processing. | The C&P Specialist can view application identifiers including: |
- Application identifier
- Practitioner identifier
- Application status
| The C&P Specialist can view any supporting documentation attached to the application. | Privileging applications capture the specific clinical activities a practitioner is requesting authorization to perform an often include supporting evidence and governance inputs that inform the final determination. C&P Specialists need a clear in-solution view of the privileging application to confirm what privileges were requested, what supporting information and documents are available for review and what the current workflow status is. | 34 | WRKFS0000105CUA.01-Verify Practitioner Credentials and Privileges-2291527-Review Credential InformationWRKFS0000105CUA.01-Verify Practitioner Credentials and Privileges-2291549-Attempt Primary Source Verification (PSV) | BR | ||
| 20251210 | Verify Practitioner Credentials and Privileges | As a C&P Specialist, I need to view application status notifications in the C&P solution, so that I can identify applications that require follow-up. | The C&P Specialist can view application identifiers in the notification including: |
- Application identifier
- Practitioner identifier
- Application status
| - Where the change is in the application | Application status changes are key workflow signals that indicate when an application has progressed, stalled, or requires action. Presenting application status updates as an in-solution notification gives the C&P Specialist a centralized way to monitor changes without manually checking each application. | 35 | WRKFS0000105CUA.01-Verify Practitioner Credentials and Privileges-2291527-Review Credential Information | BR | ||||||
| 20251210 | Verify Practitioner Credentials and Privileges | The system shall perform verification checks on professional references associated with a practitioner's credentialing application when documentation is received. | Automating professional reference verification standardizes and accelerates a critical part of credentialing. The system securely contacts listed references, presents a configurable questionnaire, captures e‑signatures, and validates responses for completeness. Built‑in reminders and deduplication improve response rates, while discrepancy flags and a manual fallback with Report of Contact preserve coverage when automation is insufficient. Role‑based access, minimum‑necessary data handling, and comprehensive audit trails support privacy and compliance, and dashboard updates keep specialists informed of progress in real time. | 36 | WRKFS0000105CUA.01-Verify Practitioner Credentials and Privileges-2291529-Interview Professional References | BR | ||||
| 20251210 | Verify Practitioner Credentials and Privileges | The system shall send a professional reference verification request to each listed reference when the practitioner submits professional reference contact information in the C&P solution. | When a practitioner submits professional reference contact information, the credentialing workflow depends on timely outreach to those references to obtain standardized verification input. Automatically sending a professional reference verification request to each listed reference ensures the outreach occurs consistently without requiring the C&P Specialist to manually contact references, reducing delays and minimizing the risk of missed requests. Generating these requests from within the solution also supports traceability by tying each request to the practitioner's application and preserving when the request was issued. | 37 | WRKFS0000105CUA.01-Verify Practitioner Credentials and Privileges-2291529-Interview Professional References | BR | ||||
| 20251210 | Verify Practitioner Credentials and Privileges | The system shall receive completed professional reference verification responses from references in the C&P solution. | Professional reference verification is only actionable once responses are returned and captured in the authoritative record. Enabling the system to receive completed professional reference verification responses from references ensures returned information is securely collected and retained within the C&P solution without relying on email attachments or offline handling. | 38 | WRKFS0000105CUA.01-Verify Practitioner Credentials and Privileges-2291529-Interview Professional References | BR | ||||
| 20251210 | Verify Practitioner Credentials and Privileges | As a C&P Specialist, I need to view professional reference verification responses in the C&P solution, so that I can confirm references have responded. | The C&P Specialist can view response details such as: |
- Response date/time
- Reference identifier
- Questionnaire responses
| - Signature/attestation | Professional reference verifications are an important input to credentialing review, but they are only useful if staff can easily access the returned response within the same authoritative application record. Providing a view of reference response status and the submitted response content in the solution allows the specialist to confirm which references have replied, review the information provided, and identify missing or incomplete responses without relying on external emails or manual tracking. | 39 | WRKFS0000105CUA.01-Verify Practitioner Credentials and Privileges-2291529-Interview Professional References | BR | ||||||
| 20251210 | Verify Practitioner Credentials and Privileges | The system shall perform verification checks on a practitioner's personal profile information to validate consistency across submitted documentation and system records. | Automated verification of personal profile information establishes identity accuracy and reduces downstream rework. The system standardizes data formats, checks consistency across attributes and documents, and detects potential duplicates before the application advances. Discrepancy flags and guided remediation help specialists quickly resolve issues, while role‑based access and minimum‑necessary handling protect sensitive identifiers. Comprehensive audit logging and clear dashboard status ensure traceability and operational visibility, enabling a fast, secure, and paper‑free credentialing workflow. | 40 | WRKFS0000105CUA.01-Verify Practitioner Credentials and Privileges-2291533-Verify Personal Profile Information | BR | ||||
| 20251210 | Verify Practitioner Credentials and Privileges | The system shall perform verification checks on supplemental attestation information provided by the practitioner. | Automated verification of supplemental attestations reduces risk and rework by validating practitioner disclosures for completeness and consistency, mapping each statement to supporting evidence, and reconciling results from external queries. | 41 | WRKFS0000105CUA.01-Verify Practitioner Credentials and Privileges-2291534-Verify Supplemental Attestation Information | BR | ||||
| 20251210 | Verify Practitioner Credentials and Privileges | The system shall surface verification check outcomes for credentialing specialist review. | Credentialing Specialists need clear visibility into verification results to determine whether an application has sufficient validated information to proceed through review and approval steps. Surfacing verification check outcomes in the application context reduces the need to navigate into multiple verification screens and helps the Specialist quickly understand what has been confirmed, what remains pending, and where discrepancies exist. | 42 | WRKFS0000105CUA.01-Verify Practitioner Credentials and Privileges-2291534-Verify Supplemental Attestation Information | BR | ||||
| 20251210 | Verify Practitioner Credentials and Privileges | The system shall perform verification checks on a practitioner's educational information. | Automated educational verification standardizes and accelerates confirmation of degrees, institutions, and completion dates. The system correlates entries with evidence and authoritative sources, detects timing or content conflicts early, and guides rapid remediation. When automation cannot resolve an item, a structured manual fallback with Report of Contact preserves continuity. | 43 | WRKFS0000105CUA.01-Verify Practitioner Credentials and Privileges-2291535-Verify Educational Information | BR | ||||
| 20251210 | Verify Practitioner Credentials and Privileges | The system shall validate consistency between the practitioner's application entries and submitted supporting documentation in the C&P solution. | Validating consistency between application entries and supporting documentation helps ensure the practitioner's record is accurate, complete, and internally coherent before the application advances through verification and approval steps. Practitioners may enter information in the application that is also reflected in uploaded documents such as license numbers, dates, identify related details, etc. and discrepancies between the two can signal data entry errors, missing documentation, or items that require follow-up. | 44 | WRKFS0000105CUA.01-Verify Practitioner Credentials and Privileges-2291536-Verify Personal Training Information | BR | ||||
| 20251210 | Verify Practitioner Credentials and Privileges | The system shall perform verification checks on a practitioner's professional training history. | Performing verification checks on a practitioner's professional training history helps ensure the education and training information used for credentialing decisions is reliable and supports the practitioner's requested role and scope of practice. Training history can include multiple programs and dates, and it may be supported by documentation such as transcripts, certificates, or completion letters; inconsistencies, gaps or missing elements can require follow-up before an application can progress. Automating these verification checks in the solution reduces manual review effort, supports consistent application of validation rules across practitioners, and strengthens traceability. | 45 | WRKFS0000105CUA.02-Perform Credentialing and Privileging Review-2290677-Perform Chief Medical Officer (CMO) ReviewWRKFS0000105CUA.01-Verify Practitioner Credentials and Privileges-2291536-Verify Personal Training Information | BR | ||||
| 20251210 | Verify Practitioner Credentials and Privileges | The system shall perform verification checks for foreign medical graduates and validation of the Educational Commission for Foreign Medical Graduates (ECFMG) certification status against submitted documentation. | Automated verification of ECFMG and foreign graduate credentials confirms certificate authenticity, holder identity, and validity dates and reconciles these against education, training, and licensure records. The solution flags name and date inconsistencies early and provides a structured manual fallback with Report of Contact when automated retrieval isn’t possible. | 46 | WRKFS0000105CUA.02-Perform Credentialing and Privileging Review-2290677-Perform Chief Medical Officer (CMO) ReviewWRKFS0000105CUA.01-Verify Practitioner Credentials and Privileges-2291537-Verify ECFMG or Foreign Graduate Information | BR | ||||
| 20251210 | Verify Practitioner Credentials and Privileges | The system shall perform verification checks on a practitioner's professional licensure against submitted documentation. | Licensure verification confirms a practitioner’s legal authorization to practice and detects board actions early. The system first performs automated license checks and reconciles outcomes with application data and evidence. When policy or source constraints demand it—or automation is inconclusive—the activity transitions to Primary Source Verification (PSV), documenting each outreach via Report of Contact and honoring the required cadence of two Good Faith Efforts before any Secondary Source Verification. | 47 | WRKFS0000105CUA.02-Perform Credentialing and Privileging Review-2290677-Perform Chief Medical Officer (CMO) ReviewWRKFS0000105CUA.01-Verify Practitioner Credentials and Privileges-2291538-Verify Licensing Information | BR | ||||
| 20251210 | Verify Practitioner Credentials and Privileges | The system shall perform verification checks on a practitioner's U.S. Drug Enforcement Administration (DEA) registration against submitted documentation. | Automated DEA verification confirms a practitioner’s authority to prescribe or handle controlled substances, including schedules, status, and any enforcement actions. Results are reconciled against application data, state status, and requested privileges to catch misalignments early. When automated confirmation isn’t possible or a primary source is mandated, the workflow transitions to PSV with documented Report of Contact and the required Good Faith cadence. Clear status computation, guided remediation, tight access controls, and comprehensive audit trails maintain speed, accuracy, and compliance across the credentialing workflow. | 48 | WRKFS0000105CUA.01-Verify Practitioner Credentials and Privileges-2291540-Verify Federal Drug Enforcement Administration(DEA) Registration | BR | ||||
| 20251210 | Verify Practitioner Credentials and Privileges | The system shall perform verification of a practitioner's State Controlled Dangerous Substances (CDS) registration and reconcile results with application data. | Automated CDS verification ensures compliance with state-level controlled substance regulations by confirming registration validity, authorized schedules, and jurisdiction alignment. Results are reconciled against DEA data and requested privileges to prevent prescribing authority conflicts. When automation fails or policy mandates, the workflow transitions to PSV with documented Report of Contact and Good Faith cadence. Clear status computation, guided remediation, tight access controls, and comprehensive audit trails maintain speed, accuracy, and compliance across credentialing workflows. | 49 | WRKFS0000105CUA.01-Verify Practitioner Credentials and Privileges-2291541-Verify State Controlled Dangerous Substance(CDS) Status | BR |
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