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DHP CREDENTIALING GUIDE, 8.5.17

* Please Note: Credentials and Requirements could change without notice.*

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This guide contains all credential requirements for HCA/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 ........................................................................................................................................................... 3

Non-employee Dependent Healthcare Professionals (DHPs) Overview ............................................................................. 4

Tier Level Definitions ....................................................................................................................................................... 5

Tier Core Requirements ................................................................................................................................................... 6

Division Requirements / Additional Information............................................................................................................... 7

DHP Request for Enrollment Form ................................................................................................................................... 8

Credentials and Requirements ........................................................................................................................................10

Credentials Located in the eDHP System .....................................................................................................................10

Online Application & Acknowledgement Card/Addendum .......................................................................................10

Scope of Service Form Review .................................................................................................................................10

MidAmerica Annual Safety Training .........................................................................................................................10

Division Orientations ...............................................................................................................................................10

Company/Individual Information Needed ...................................................................................................................10

Letter of Compliance ...............................................................................................................................................10

Job Description........................................................................................................................................................11

Government Issued Photo ID ...................................................................................................................................11

Headshot Photo ......................................................................................................................................................11

Competencies Skills Checklist (Clinical DHPs) ...........................................................................................................12

Classifications that require a Competencies/Skills Checklist .................................................................................13

Healthcare Training .....................................................................................................................................................16

Operating Room Protocol Training ..........................................................................................................................16

HIPAA Training ........................................................................................................................................................16

Professional License or Certification ........................................................................................................................16

BLS (Basic Life Support) – Healthcare Provider or Provider Card ..............................................................................16

Certificate of Insurance ...............................................................................................................................................17

Background Report Requirements ...............................................................................................................................18

Individual Background Check Results .......................................................................................................................18

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Additional Background Requirements .....................................................................................................................19

Alaska State Requirement: ..................................................................................................................................19

Mississippi State Requirement: (Tier 2 and 3 only) ...............................................................................................19

Nevada State Requirement: .................................................................................................................................19

Missouri State Requirements: (ALL Tiers) .............................................................................................................20

How to Complete the Additional Background Requirements ...................................................................................21

Missouri ..............................................................................................................................................................21

Health Requirements ..................................................................................................................................................22

TB Test / PPD...........................................................................................................................................................22

Flu Vaccination Information ....................................................................................................................................23

Varicella Documentation .........................................................................................................................................23

MMR Documentation ..............................................................................................................................................24

Hepatitis B Documentation .....................................................................................................................................25

Tdap Documentation...............................................................................................................................................26

Drug Screen.............................................................................................................................................................26

San Antonio Specific Credentials .................................................................................................................................27

Tier 1 .......................................................................................................................................................................28

Tier 2/3 ...................................................................................................................................................................29

Tier and Core Requirements ....................................................................................................................................32

Systems and Process Information....................................................................................................................................34

Statuses of Profiles ......................................................................................................................................................34

Types of Files/Process .................................................................................................................................................35

eSAF Process ...............................................................................................................................................................36

Payments ....................................................................................................................................................................37

Contact Information ........................................................................................................................................................38

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Updates Summary This section is to briefly inform you of the updates, changes and clarifications made to this version of the Internal Management Credentialing Guide as of 8/5/17

• Pg. 5 – Out of scope individuals: Government Employees and SANE nurses for Mountain Division or any SANE nurse from a government or state agency

• Pg. 14 – LOC – If the DHP is self-employed they may write their own LOC but must be co-signed by someone they work for/under.

• Pg. 15-17 – Skills Checklist Classifications have been updated.

• Pg. 26 – Background Check – Criminal – must be a nationwide, 7 year search (or a minimum of a 7 year search within 5 counties)

• Pg. 38 – Home tests and saliva screenings are not acceptable.

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Non-employee Dependent Healthcare Professionals (DHPs) Overview All non-employee DHPs who affect PATIENT CARE, TREATMENT OR SERVICES in any Company-affiliated facility or subsidiary, including, but not limited to, hospitals, ambulatory surgery centers, outpatient imaging centers, and physician practices.

Included within the scope of this policy are any DHPs who are providing patient care services using telehealth technology (e.g., RNs performing telephone triaging for a Company-affiliated emergency department from an off-site location).

In addition, all non-employees, aka Tier 1, accessing safety- or security-sensitive areas of any Company-affiliated facility or subsidiary are included within the scope of this policy.

These individuals are not in scope: • HCA employees • Physicians, Dentists, NPs, PAs, Podiatrists, ARNPs, and other APP/LIPs (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 • Organ Procure Organizations • Sexual Assault Nurse Examiner (SANE) (Mountain or any SANE nurses from a government or state agency) • Government Employees

If you discover an HCA employee in our system that would wish to work in a dual role, escalate to management with detailed information (name, division, facility, agency, current classification, classification they would like to work as) and write detailed diary notes.

When you come across a DHP in the system (or a file that you are working/have been assigned) and discover that the individual is a APP/LIP etc. we need to allow some time for the transition to be credentialed through HCA. That being said please DO NOT deactivate the account or suspend working the file. We have to allow a grace period for the transition to occur. We will provide a grace period until these individuals have completed the transition. Please connect with your Lead and Manager for guidance when these discoveries are made. As of 11/2015, Therapeutic Physicists from CA need to be credentialed through the Central Processing Center (CPC) aka MSO- Medical Staffing Office at the facility. Whenever you get questions or people trying to “dispute” that a clinical worker who is an APP/LIP will be utilized to a lesser service than their licensure actually permits, reply with the following:

The Ethics Policy, CSG.QS.003, states that we would not credential any LIPs or APPs through the DHP process. The determination is based on level of licensure, training and education – not scope of services/patient care.

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.

Distributors & StaffPM If you receive notification that a DHPs company has gone through a Company Acquisition/Name Change DO NOT request this documentation from the DHP. Notify management to obtain the correct documentation to implement the necessary change.

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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

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.

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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 Additional credentials may be required to complete the credentialing process.

TIER 1 TIER 2 & 3 • Online Application & Acknowledgement Card/Addendum

(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 Employment History Verification (7 yrs) o Social Security Number Verification o Criminal Search Verification (7yrs) o Violent Sexual Offender o OIG/GSA List of Excluded Individuals o OFAC SDN Search

San Antonio – performed within 30 days of acct submission • Flu Vaccine (when applicable) • Annual Credentialing Fee (paid online)

• Online Application & Acknowledgement Card/Addendum • 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) Be sure to verify term lengths

o Criminal Search Verification (7yrs) o Education – a review of an original diploma or certification

that demonstrates completion of high school (or equivalent) education course or degree. Typically the highest level of education be it high school/GED or degree is required to be validated. As a Tier 2 or 3 DHP, there may be specific educational requirements to meet. Therefore, always review the Scope of Services for the classification. (all DHPs, except HCIR)

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

San Antonio – performed within 30 days of acct submission • Licensure/Certification Verification

[state boards and will be PSV by HWS] (when applicable) • Chest X-Ray - TB Annual Signs/Symptoms Form (if positive TB) • 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

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Division Requirements / Additional Information 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) (ALL HCIRS do not need the Garden Park requirement) MA- Annual Safety Training Manual

MA- Annual Safety Training Manual

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

DOES NOT HAVE AN ORIENTATION 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) (ALL HCIRs do not need MO EDL) 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 Security Guards only: equivocal titers are acceptable.

MMR, Varicella – Titers / Hep B – Innoculation Series TDap Drug Screen completed within 30 days of eDHP submission Mask Fit Test All Other DHP’s No Additional Requirements at This Time

TRISTAR Drug Screen, MMR, Varicella, Hepatitis B MOUNTAIN TB Test required upon initial credentialing only,

Alaska Regional Only: State Background Check & Drug Screen TB Test required upon initial credentialing only

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)

Drug Screen Requirements where required Amphetamines Marijuana Barbiturates Methadone Benzodiazepines Opiates Cocaine

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DHP Request for Enrollment Form Form Located: Location to DHP Forms Email to: [email protected]


mailto:[email protected]

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Credentials and Requirements

Credentials Located in the eDHP System

Online Application & Acknowledgement Card/Addendum • This is the setup of your account and attesting to terms and conditions. • Reoccurrence: Annual

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

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

MidAmerica Annual Safety Training • Formal document created to assist in understanding the key components of MidAmerica’s safety and emergency

preparedness procedures. Training is available here • Reoccurrence: Annual

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

Capital East, North, West Florida Mountain South Atlantic Continental Far West North Texas Tristar Central and West Texas MidAmerica (Midwest /Delta) San Antonio

Company/Individual Information Needed

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

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

o If the DHP is self-employed they may write their own LOC but must be co-signed by someone the work for/under. In addition, the DHP may provide proof of business ownership through primary source verification (i.e. 1099) or listed on state website (i.e. Sunbiz for FL, etc.) or a Certificate of Ownership for Unincorporated Business.

o If the DHP is a sales representative, they must list every Agency they distribute for within one LOC. o Document may include the hire date if it is not included in the background report to supplement the current

employment verification, does not need a signature. o If your employer took part in facilitating your training for HIPAA and/or OR Protocol and Aeseptic Techniques, the

Letter of Compliance may also serve as an attestation.


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

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

o What to include on the document: Current Employing Company letterhead/Company Name Title of Job/Position Basic responsibilities Qualifications License, Certification, Education Skills

o Must be typed and legible o Please do NOT submit JDs tailored for non-HCA facilities or Physician based practices o Document may include the hire date if it is not included in the background report to supplement the current

employment verification, does not need a signature.

Government Issued Photo ID • 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 • Reoccurrence: Once upon initial application

o Clear, frontal headshot with light background. Photo needed for eDHP Kiosk badging system

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Competencies Skills Checklist (Clinical DHPs) • A yearly evaluation completed by the employer that shows proof of current assessment done on the DHP and their

competency skills to perform their job. The skills checklist can list soft skills along with daily tasks and procedures. • Reoccurrence: Annual

o Checklists would need to include the following: Must be completed within the last year. If training is needed, must supply a hard date for re-evaluation on the form and submit a new checklist upon

completion/re-evaluation to ensure competency and proper training in their position. The Title of the evaluator must be clear and legible. Must be signed by Evaluator

• Evaluation may be completed by: Employer/Human Resources, Supervisor, A Peer working within the same Classification/Scope of Service, Sponsoring Physician if DHP is self-employed

Forms must be filled out in their entirety Supporting documentation may be attached (if applicable)

o If your company does not have a standardized skills checklist to use for experienced and/or newly hired DHPs, see our attached template. Experienced employees will complete Section A. Newly hired employees will complete both Sections A and B.

o If your company does have standardized skills checklist to use for experienced and/or newly hired DHPs, that document may be submitted to satisfy the credential. NEWLY HIRED DHPs who have not achieved/passed/completed training required for the position (not the

company related training), would need to complete a checklist that contains a detailed plan for on the job training (OJT) that includes the list of missing skills that will be attained during OJT, as well as a re-evaluation date. The re-evaluation date is necessary so that HealthTrust may follow up and retrieve an up to date Skills Checklist. This will then confirm the competency of the DHP. If the documentation does not include this piece, then the company needs to complete Section B (page 3) of the HealthTrust Skills Checklist document and submit with their company documentation.

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Classifications that require a Competencies/Skills Checklist Y- Indicates a requirement for a Competencies/Skills Checklist. Left Blank indicates it is not a requirement.

Acupuncturist Y Acute Culture Technician Y Administrative Assistant

Admission Director Y Admission Liaison Y Admission Nurse Y Anesthesia Assistant RN Y Anesthesia Care Coordinator Y Anesthesia Technician Y Apheresis Nurse-LPN Y Apheresis Nurse-RN Y Apheresis Nurse-RN Supervisor Y Athletic Trainer Y Audio Testing Technician Y Audiologist Y Autopsy Assistant (Diener) Y Autotransfusionist - Non Certified Y Autotransfusionist- Certified Y Bariatric Nurse Y Billing Coordinator

BioMedical Technician

Birth Doula Y Brachytherapy Specialist Y Cancer Exercise Trainer (Certified) Y Cancer Registry Assistant Y Cardiac Nurse Y Cardio Vascular Tech - Noninvasive Y Cardio Vascular Tech -Invasive Y Cardiovascular Perfusionist Y Cardiovascular Perfusionist-Non Certified

Y

Care Manager - Clinical Y Case Management Assistant Y Case Manager - Clinical Y Case Manager - Hospice Y Case Manager - Navigator Y Case Manager - Non-Clinical Y Cast Tech Y Cath Lab Director Y Cellular Therapy Manager Y Cellular Therapy Specialist Y Certified Music Therapist Y Certified Nuclear Medicine Tech Y Certified Nurse Operating Room Y Certified Nursing Assistant Y

Certified Ophthalmic Assistant Y Certified Ophthalmic Technician Y Certified Orthotist Y Certified Registered Nurse First Assist

Y

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

Child Advocacy Services Coordinator

Y

Clinical Allergy Specialist Y Clinical Liaison Y Clinical Liaison (ABATE Study) Y Clinical Liaison (LPN) Y Clinical Liaison (LVN) Y Clinical Liaison (Respiratory Therapist)

Y

Clinical Liaison (RN) Y Clinical Liaison (Social Worker) Y Clinical Nurse Manager Y Clinical Nutrition Manager Y Clinical Program Manager Y Clinical Program Manager-Wound Care

Y

Clinical Research Associate-Monitor

Clinical Research Coordinator-Assistant

Y

Clinical Technician Y Coder/Biller

Compliance Specialist

Concurrent Review RN Y Consulting Pharmacist Y Cosmetologist

Courier/Driver

Crisis Care Lic Vocational Nurse Y Cryotherapy Technician Y Customer Service Representative Y Cytotechnologist Y Data Collector

Death Doula Y Dental Assistant Y Dental Hygienist Y

Diagnostic Imaging Physicist Y Diagnostic Imaging Physicist Associate

Y

Dialysis Coordinator Y Dialysis Nurse - LPN Y Dialysis Nurse - RN Y Dialysis Technician- Non Certified Y Dialysis Technician-Certified Y Dialysis Transporter Y Dietitian Y Director Hospital Laboratory Y Discharge Dictator Y Discharge Dictator-Remote Access

Discharge Nurse Y Discharge Summary Assistant Y Domestic Violence Patient Advocate

Y

Dosimetrist Y Echo CV Tech -Non Invasive Y Echo Tech Y ECMO Technician Y Educator Y Electroencephalography (EEG) Technologist-Certified

Y

Electroencephalography (EEG) Technologist-Non Certified

Y

Embryologist Y Endoscopy Technician Y Environmental Service Coordinator

Ethicist Y Executive Chef Y External Pharmacy Delivery Tech Y Fluroscopy Radiology Technologist Y Genetic Counselor Y GI Rounding LPN Y GI Rounding RN Y Greeter

Grief Counselor

Grossing Technician Y Hazardous Waste Technician

HCIR-Health Care Industry Rep

HCIR-Pharmaceutical Rep

Healthcare Industry Rep Manager

Histology Technician Y HistoTechnologist Y

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Hospice Nurse LPN Y Hospice Nurse RN Y Hospice Nurse Triage Supervisor Y Hospice Representative Y Hospitalist RN Y Hygiene Technician Y Hyperbaric Technologists- Certified Y Hyperbaric Technologists Non-Certified

Y

Hyperbaric Technologists Supervisors

Y

Hypnotherapist Y Industrial Hygiene Tech

Infusion Nurse Y Insurance Case Manager Y 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

Intraoperative Neurophysiologic Technician

Y

Inventory Technician

Investigator - Abate Project

IT Support

Laboratory Assistant Y Lactation Consultant Y Laser Technician Y Laser Technician-Clinical Y Lead Ambassador Y Licensed First Surgical Assistant Y Licensed Medical Health Physicist Y Licensed Professional Counselor Y Licensed Radiology Tech Y Licensed Surgical Assistant-LSA Y Lithotripsy RN Y Lithotripsy Tech Y Maintenance Tech

Mammographer Y Massage Therapist-Certified/Licensed

Y

Medical Assistant Y Medical Photographer

Medical Physicist Assistant Y Medical Technician Y Medical Transcriptionist Y

Medical Transporter Y Medical Videographer Y Mental Health Assessor Y Mobile Image Provider

Neonatal Photographer

Neurodiagnostics Tech Y Neurophysiologist Y Neuropsychology Technician Y Neuroscience Nurse Y Newborn Hearing Screener Y Nutritional Services-Non Clinical Y Occupational Therapist-Assistant (Certified)

Y

Occupational Therapist-Certified Y Ocularist Y Oncology Certified Nurse (OCN) Y Oncology Nurse Y Operating Room Nurse Y Ophthalmic Technician (Certified) Y Ophthalmic Technician (Non-Certified)

Y

OR Technician Y Orthopaedic Physician Assistant Y Orthopedic Technician-Certified Y Orthopedic Technician-Non Certified

Y

Orthotic/Prosthetic Resident Y Orthotist /Prosthetist Assistant Y Orthotist/Prosthetist Y Ostomy Care Nurse Y Outreach Specialist Y Pathology Assistant Y Pathology Technician Y Patient Advocate

Patient Care Coordinator Y Patient Care Technician Y Patient Services Representative Y Pedorthist Y Perfusion Assistant Y Pet-CT Technologist Y Pharmacist Y Pharmacy Technician Y Phlebotomist Y Physical Therapist Y Physical Therapy Aide Y Physical Therapy Assistant Y Physicist Y Physicist Assistant Y Picc Line Nurse Y

Polysomnography (PSG) Technician-Non-Certified

Y

Polysomnography (PSG) Technologist-Certified

Y

Post-Op Nurse Y Pre-Op Nurse (LPN/LVN) Y Pre-Op Nurse (RN) Y Program Coordinator Y Program Director Y Psych Nurse Y Psychometrist Y Psychosocial Specialist Y Radiation Inspector Y Radiation Physicist - Diagnostic Y Radiation Physicist - Medical Y Radiation Physicist - Nuclear Y Radiation Physicist - Therapeutic Y Radiation Therapist Y Radiology Clerk Y Radiology Consultant Y Radiology Technologist Y Recovery Technician Y Recreation Therapist Y Regional Director Hospital Laboratory

Y

Registered Nurse First Assist (RNFA)

Y

Registered Nurse Special Care Unit (RN-SCU)

Y

Registered Orthopedic Technologist

Y

Remote EEG Tech Y Research Coordinator-Assistant-Licensed

Y

Research Coordinator-Assistant-Non-Licensed

Y

Respiratory Therapist Y Rounding Nurse-LPN Y Rounding Nurse-LVN Y Rounding Nurse-RN Y SAN-Surgical First Assist Y SAN-Surgical Registered Nurse Y Scribe Y Security Guard -APO

Security Guard Armed

Security Guard Unarmed

Security Guard/Driver Y Senior Coordinator- ABATE Project Y Sexual Assault Nurse Examiner (SANE)-Certified

Y

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Sexual Assault Nurse Examiner (SANE)-Non Certified

Y

Sitters

Social Worker -Licensed Y Social Worker -Non Licensed Y Sonographer Y Speech Pathologist Y Sterile Processing Technician Y Surgical Assist (Non Certified/Non Licensed)

Y

Surgical Assistant-RN Y Surgical Scrub Technician (Non-Certified/Non-Licensed)

Y

Surgical Technician (Non-certified/Non-Licensed)

Y

Tech Specialist Y Tech Specialist-Lean Supply Y Tech Specialist-LIS Y Tech Specialist-POC & Safety Y Tech Specialist-Pre Analytical Process

Y

Tech Specialist-QA Leader Y Tech Specialist-Transfusion Medicine

Y

Technical Specialist- Microbiology Systems

Y

Technologist Assistant Y Transition Coordinator Y Unit Assistant

Vascular Access Nurse Y Vascular Tech - Non-Invasive Y Wound Care Nurse (LPN) Y Wound Care Nurse (RN) Y Wound Care Tech Y

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Healthcare Training

Operating Room Protocol Training • 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. • Reoccurrence: Once upon initial application, unless undergoing the Vendor Change Process

o Only applicable to DHPs requesting access to the Operating Room o Certificates of training may be accepted by a qualified vendor organization o The certificate must include the vendor company logo, person’s name testing, name of training and date completed. o HealthTrust also provides an Attestation of Satisfactory AORN Requirements form that can be completed by the DHP’s

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

• Reoccurrence: Once upon initial application, unless undergoing the Vendor Change Process o Certificates of training may be accepted by a qualified vendor organization o The certificate must include the vendor company logo, person’s name testing, name of training and date completed. o Company Policies are not acceptable without the confirmation of the DHP’s training along with their completion dates. o 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 • Reoccurrence: Upon expiration of the current Professional License or Certification

o According to StaffPM, Division Specific Scope of Service Form, and Job Description, submit any professional licenses or certifications required for the Classification.

o DHPs with a compact license will need to fill out the Compact License Declaration of Residency Form

BLS (Basic Life Support) – Healthcare Provider or Provider Card • Reoccurrence: Upon expiration of the Card (every 2 years)

o The only acceptable card is from the American Heart Association or The Red Cross. o The Physical card must have the DHP’s name, signature and an expiration date o Must submit copies of the front and the back of the card. (back of card provides instructor/location)-(If not an e-Card). o AHA eCards are acceptable. Must be the entire eCard, no cut offs.

Do not send the link to your credentialing specialist. Save the card down to a PDF or JPG or a screen shot saved. o 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. o Healthcare Provider Card is different training than the AHA CPR Card (for anyone who wants to be certified, not

necessarily healthcare providers) o 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/

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Certificate of Insurance • Proof of General Coverage Liability, Product or Professional liability coverage for the DHP. Please refer to the Certificate of

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

o Examples of 3rd Party Individuals verbiage: Insurance covers all Distributors and Independent Representatives. o Umbrella Liability Coverage verbiage must state the policy/coverage it applies to. o Medical Malpractice is Professional Liability on some policies. o 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 (if separate policy) 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

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Background Report Requirements

Individual Background Check Results • Satisfactory Background Check (no attestations are accepted), with redacted Social Security numbers, Credit Report

Results, and/or Salary Information that meets the requirements below. • Reoccurrence: Once upon initial application, unless an attestation was originally submitted. • San Antonio requirement that the background be no older than within 30 days of submission. • The summary page that usually fronts the results may be enough to meet the credential requirement. This would need to

be reviewed and approved by DHP HealthTrust Management.

• 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 state website (ie. Sunbiz)

Background Check Provider Option If you need access to a background check provider below is the link to our valued partner who will provide exactly what you need and at a reasonable cost. Click Here for Account Setup and Information

Tier Background Check Compliance Sub-Requirements

1, 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 90 days (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. HWS 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 A 7 year nationwide search (may submit a 7 year search with a minimum of 5 counties, within 50 states) • If there are convictions, HWS must be made aware of the details • No pending cases

2, 3 (ALL except HCIR)

Education Verification A review of an original diploma or certification that demonstrates completion of high school (or equivalent) education course or degree. Typically the highest level of education be it high school/GED or degree is required to be validated. As a Tier 2 or 3 DHP, there may be specific educational requirements to meet. Therefore, always review the Scope of Services for the classification.

2, 3 Does not reveal any disciplinary actions/exclusions If there are disciplinary actions/revocations/ suspensions, HWS must be made aware of the details

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 Exclusions

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

https://www.evoconreceive.com/Healthtrust/DHP/HealthtrustDHP1.php/

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Additional Background Requirements

Alaska State Requirement: • Reoccurrence: Once upon initial application, unless undergoing the Vendor Change Process • This is required for a Proximity Badge at Alaska Regional Medical Center & Surgery Center of Anchorage. • 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. o Depends on DHPs classification and/or if they need escorted or unescorted access to the hospital. o Alaska Regional Hospital informs the HealthTrust Team Lead (Mountain Division) via email to inform the DHP whether

or not the Alaska Background is needed. o Any questions in regards to the Alaska Background Check, you may contact Alaska Regional at 907.264.1777 or call the

State of Alaska directly at 907.334.4475

Mississippi State Requirement: (Tier 2 and 3 only) • Reoccurrence: Once upon initial application • This is required for access to Garden Park Medical Center. • 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 and with DHP’s current agency (if the DHP changes agency, he/she will need new prints).

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.

Nevada State Requirement: • Reoccurrence: Once upon initial application • This is a State Statue for the Government not an HCA requirement.

o Background checks and fingerprinting through Nevada Records of Criminal History is required of all DHPs regardless of the Line of Business

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Missouri State Requirements: (ALL Tiers) MO Highway State Patrol Check

• 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 • You can perform the MO State Hwy Patrol Check (Missouri State Requirement) yourself by visiting the website

https://www.machs.mshp.dps.mo.gov/MocchWebInterface/home.html. You will need to create an account and pay $13.00, print the report and send it to us. The report is available almost immediately. The document, when printed has a seal in the upper left corner, will include the findings of the search and has a Watermark on the background. o 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 o 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. o County searches are not acceptable for the MO Highway State Patrol Check.

MO Employee Disqualification List (MO EDL) • A requirement with regards to Facility-Based screenings for HCA/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 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) • You can use Google Chrome to access this link for the MO EDL Form

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

These are 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

https://www.machs.mshp.dps.mo.gov/MocchWebInterface/home.html

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

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How to Complete the Additional Background Requirements

Missouri

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.

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Health Requirements Immunizations will no longer require a signature. However, 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, 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.: We can accept proof from other countries as long as documented as we would within the US. Even if the schedule is off, as long as the shots are met within/but not before mandated schedule we can accept.

The recommended immunization schedule for a child who began receiving vaccines in another country depends on whether the vaccines the child received:

1. Have been documented in writing and dated; and 2. Have been given at the ages and spacing recommended in the U.S.

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

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

Management.no o Date read must be within 48-72 hours of test administered o 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.

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

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

PPD/TB results. Only the TB Questionnaire must be updated annually - form available here. o 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) o 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) along with an evaluation from an infectious disease physician

https://staffrx.app.medcity.net/StaffDHP.Net/Documents/pdf/HEALTH/Immunization%20Waiver-Questionnaire.pdf

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Flu Vaccination Information • Reoccurrence: Only during flu season – November 1st to April 1st

o If declining must submit HealthTrust’s declination form; forms only available at the start of each season o If declining, the reason must be selected. o Flu receipts can only be accepted if it contains DHP’s name, administered date, clearly states Flu was given. o Nasal flu NASAL flu mist is not available due to low efficacy and will not be honored for vaccination compliance

Varicella Documentation • Acceptable proof of vaccinations or positive titer results • Reoccurrence: Once upon initial application

Immunity Status Results/Action Next Steps

Serologic Evidence of Immunity VZV Ab IgG) >/= 1.10 Obtain copy of documentation. No further action

Evidence of vaccination with two (2) doses of Varicella vaccine at least 28 days apart - OR - Physician diagnosis of disease

Obtain copy of documentation. No further action needed.

No Evidence of vaccination with 2 doses of Varicella vaccine at least 28 days apart – OR – Physician diagnosis of disease

Draw Titer. Action based on titer results.

Serologic Evidence of Non-Immunity

VZV Ab(IgG) </= .90 Vaccination. 2 doses at least 4 to 8 weeks apart.

MMR and Varicella – If two live virus vaccines are inadvertently given less than 4 weeks apart, what should be done? If two live virus vaccines are administered less than 4 weeks apart and not on the same day, the vaccine given second should be considered invalid and repeated. The repeat dose should be administered at least 4 weeks after the invalid dose. Alternatively, titers are acceptable.

o History of childhood illness is not considered proof of immunity in TEXAS ONLY o South Atlantic Division – Grand Strand Medical Center DHPs can decline Varicella with the declination form found here o San Antonio Division – DHPs must follow CDC vaccine schedule if series is not complete. (Titers acceptable)


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


Serologic Evidence of Immunity Ab (IgG) >/= 1.10 for all 3 components

Obtain copy of documentation. No further action

Evidence of serological immunity OR documentation of two (2) doses MMR vaccine

Obtain copy of documentation. No further action needed.

No Evidence of vaccination with 2 doses of MMR or serologic immunity

Draw Titer. Action based on titer results.

Serologic Evidence of Non-Immunity to each Measles (Rubeola), Mumps, and Rubella

Ab(IgG) </= .90 for each Measles (Rubeola), Mumps, and Rubella

Vaccination of two (2) doses of MMR vaccine 4 weeks apart. No need to perform post-vaccination serological testing

MMR and Varicella – If two live virus vaccines are inadvertently given less than 4 weeks apart, what should be done? If two live virus vaccines are administered less than 4 weeks apart and not on the same day, the vaccine given second should be considered invalid and repeated. The repeat dose should be administered at least 4 weeks after the invalid dose. Alternatively, titers are acceptable.

o Must be 1 or 2 doses when providing vaccine records (Midwest Division requires proof of 2 doses) o Regardless of CDC Guidelines, if the DHP is born before 1957 they must submit proof of immunity for Mumps (MMR). o San Antonio Division – DHPs must follow CDC vaccine schedule if series is not complete. (Titers acceptable)

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Hepatitis B Documentation • Proof of three vaccinations series or positive titer results • Reoccurrence: Once upon initial application


No Previous Vaccination Require 3 doses. If DHP declines vaccination, DHP must sign declination form. This does not guarantee access will be granted. Per HCA guidelines, if a vaccine is given earlier than the listed timeframe, a titer must be submitted to show evidence of immunity.

Schedule is 0, 1, 6 To log in StaffPM where you are able: Dose #2 given 30 days after Dose #1; Dose #3 given at 5 months after dose #2.

Previous Vaccination Unknown Immunity

Draw Titer Action Based on Results

Previous Vaccination Non-Immune

HBsAB <10mlU/mL Vaccination of 1 dose of Hep B vaccine and perform post serological testing after 30 days. If repeat Anti-HBs is <10mlU/mL (no immunity), administer 2 additional doses of Hep B vaccination. Dose #3 to be administered 5 months after dose #2) and repeat titer 30 days after dose #3. If DHP declines vaccination must sign declination form

Serologic Evidence of Immunity HbsAB > 10mlU/mL No Further Action – Have DHP sign declination form

o Twinrix (Combination of HEP A & B) and Recombivax are forms of the Hep B Vaccination o If declining, must submit DHP HealthTrust’ s declination form; Declination Form available here o San Antonio Division – DHPs must follow CDC vaccine schedule if series is not complete. (Titers acceptable)


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

o Tdap cannot be declined if requesting access to Maternity & Nursing areas in the hospital, regardless of division/tier, unless there is a valid medical reason within a division that does not traditionally require it.

o Vaccination records for Td or DTaP are not acceptable o Adacell and Boostrix are forms of the Tdap Vaccination o Tdap titers do not expire o If declining, must submit DHP HealthTrust’s declination form; Declination Form available here

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

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

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

the DHP’s employer – form available here. All sections of the form must be completed. Self-employed DHPs cannot use this form.

o Diluted drug screening - urine specific gravity should be in the range of 1.003 – 1.030. Any screening outside these ranges will have to be repeated.

o Home tests and saliva screenings are not acceptable. o Mountain Division – Alaska Regional Hospital & Surgery Center of Anchorage – a drug screen is needed for this facility.

Must meet current requirements. o San Antonio Division – must have been performed within 30 days of submitting account for credentialing review.

Attestations not acceptable for this division


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

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San Antonio Specific Credentials San Antonio has unique requirements as well as may have classifications of DHP that may require an additional classification to be added to an existing DHP user’s account. This would be due to unique requirements on the classification that are not required in another Division’s facilities. For Example: Dialysis Nurse does exist in eDHP; however, San Antonio has their own unique Dialysis Nurse requirements so there would be two classifications to credential. All the requirements would then automatically load for San Antonio. There might be instances where there is duplication of effort in the credentialing.

Where one credential may be met with documentation in one division may NOT necessarily apply to San Antonio. For that reason we have supplied on the following pages the San Antonio Division specific credentials.

ALL TIERS: Three Tiers are designated for DHPs (1, 2, 3). All required the following credentials within eDHP

• Online Application & Attestations: Attested to online

• Annual Credentialing Fee (paid online)

• Photo ID: Government issued photo ID

• Job Description: Must be specific to include only, the duties performed when working in the HCA Hospital or Surgery Center. Must be on company letterhead and have job title and duties listed.

• Flu Vaccine (when applicable): May submit proof of vaccination. May also submit proof of declination. Form located on HCA Health Forms

• Orientation (online via eDHP): Attested to online under the “Orientation Manuals” tab in your eDHP acct.

• Letter of Compliance: This is verification of current employment and date of hire. Tier 2 & 3 LOC should also include training and competencies



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Tier 1

Background Check Results:

Satisfactory Background Check (no attestations are accepted), with redacted social security number, that meet the requirements below and has been performed within 30 days of submitting your file.

The summary page that usually fronts the results may be enough to meet the credential requirement. This would need to be reviewed and approved by DHP HealthTrust Management.

Required elements:

• Criminal Search Verification (7 years)

• Social Security Number Verification

• Violent Sexual Offender/Predatory Registry Search

• OIG/GSA List of Excluded Individuals

• OFAC SDN Search

*If you need access to a background check provider below is the link to our valued partner who will provide exactly what you need and at a reasonable cost. Click Here for Account Setup and Information

Negative TB Test or T-Spot & TB Questionnaire: San Antonio Health Forms

Results of tuberculin test must include date test administered and health center where test was performed and is required annually. Please click [link] to download the TB Questionnaire.

The below three options can be used to fulfill the requirement:

• Negative TB

• Negative TSPOT (blood draw) & Questionnaire

(less than two yes answers only, if more than two yes answers must follow option C)

• Positive TSPOT (blood draw); Questionnaire; Infectious disease/Pulmonary Physician evaluation letter

o If known to be positive, Methodist requires a TB blood test. The DHP will also fill out the TB screening questionnaire.

o If the TB blood test result is positive or equivocal, the DHP (at their own expense) will need to see an infectious diseases

or pulmonary physician or to the City Chest Clinic for evaluation.

o The individual will not be cleared to begin employment until this evaluation is completed and the results submitted.

Tetanus, Diphtheria, and Acellular Pertussis (only for Tier 1 Neonatal Photographers): Proof of titer results showing immunity or proof of one dose of the vaccine.


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

https://staffrx.app.medcity.net/StaffDHP.Net/Documents/pdf/SAN_HLTH/SAN_HLTH_TB%20Questionnaire%20San%20Antonio.pdf

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Tier 2/3

Background Check Results:

Satisfactory Background Check (no attestations are accepted), with redacted social security number, that meet the requirements below and has been performed within 30 days of submitting your file.

The summary page that usually fronts the results may be enough to meet the credential requirement. This would need to be reviewed and approved by DHP HealthTrust Management.

Required elements:

• Previous Employment History Verification (7 years) o Surgical Techs will need to provide 10 years of employment history verification

• Criminal Search Verification (7 years)

• Education – per what is requested on the Scope of Service (ALL except HCIR)

• Social Security Number Verification

• Violent Sexual Offender/Predatory Registry Search

• OIG/GSA List of Excluded Individuals

• OFAC SDN Search

*If you need access to a background check provider below is the link to our valued partner who will provide exactly what you need and at a reasonable cost. Click Here for Account Setup and Information

Negative TB Test or T-Spot & TB Questionnaire: San Antonio Health Forms

Results of tuberculin test must include date test administered and health center where test was performed and is required annually. Please click [link] to download the TB Questionnaire.

The below three options can be used to fulfill the requirement:

• Negative TB

• Negative TSPOT (blood draw) & Questionnaire

(less than two yes answers only, if more than two yes answers must follow option C)

• Positive TSPOT (blood draw); Questionnaire; Infectious disease/Pulmonary Physician evaluation letter

o If known to be positive, Methodist requires a TB blood test. The DHP will also fill out the TB screening questionnaire.

o If the TB blood test result is positive or equivocal, the DHP (at their own expense) will need to see an infectious diseases

or pulmonary physician or to the City Chest Clinic for evaluation.

o The individual will not be cleared to begin employment until this evaluation is completed and the results submitted.

Scope of Service documentation: Located on the DHP site

HIPPA Training: This may be attested to by your employer or you can provide proof of a certificate.



https://staffrx.app.medcity.net/StaffDHP.Net/Documents/pdf/SAN_HLTH/SAN_HLTH_TB%20Questionnaire%20San%20Antonio.pdf


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OR Protocol Training/AORN (only IF working on OR): This may be attested to by your employer or you can provide proof of a certificate.

Skills Checklist/Competencies (only applies to Clinical DHPs): Template form needs to be filled out for this requirement and can be located on the DHP site.

License/Certification: Must correlate to the qualification requirements listed on the Scope of Service that applies to the San Antonio Division.

Certificate of Insurance

Drug Screen:

Satisfactory Drug Screen results (employer attestations are not accepted) for the following substances: amphetamines, barbiturates, benzodiazepines, opiates, marijuana, methadone, and cocaine in order to meet HCA's minimum requirements. Substances tested for must be listed. Note this is not a 7 panel as that will not include the 7 drugs required. The Drug Screen must be performed within 30 days of submitting your application for review.

Measles, Mumps, Rubella: San Antonio Health Forms

Proof of immunity against measles, mumps and rubella. Must include date test administered and health center where test was performed. Please submit MMR shot records or titers showing immunity; equivocal results are not considered immune.

Must be 2 doses when providing vaccine records.

May decline for the below reasons (see site for specific forms):

a. Conscientious

b. Religious

c. Medical

Varicella: San Antonio Health Forms

Proof of immunity against Varicella (VCZ). Must include date test administered and health center where test was performed. Please submit Varicella shot records (2 doses) or titers showing immunity. Attestations of disease are not accepted.


a. Conscientious

b. Religious

c. Medical

Tetanus, Diphtheria, and Acellular Pertussis: Proof of titer results showing immunity or proof of one dose of the vaccine.




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Hepatitis B: San Antonio Health Forms

Proof of three Hepatitis B series vaccinations. Shots must be given in increments of three months. First shot should be given at 0 months, second shot should be given at 1 month, third shot should be given at 6 months. If a vaccination schedule is missed, you will become noncompliant to work

The credential must include date test administered and health center where immunization received. Titer can be provided and must be positive; equivocal results are not considered immune.


a. Conscientious

b. Religious

c. Medical

N-95 (Aurora 1870+, 3M 1860 Health Care Respirator, 3M 1870+ Health Care Respirator) Mask Fit Test:

Each DHP must perform an annual N-95 (Aurora 1870+, 3M 1860 Health Care Respirator, 3M 1870+ Health Care Respirator) Mask Fit Test. Proof of a pass or fail result must be visible. If the Mask Fit Test indicates a non-passing result, you will need to understand that due to your occupational exposure to potentially infectious disease, you will not able to enter a "Respiratory Isolation" room. You will be required to wear a (PAPR) Positive Air Powered respirator to enter a "Respiratory Isolation" room by signing the N95 Fit Test Declaration Form located on our DHP site. You can pick up a mask at any Methodist Hospital location or at 8109 Fredericksburg Rd., San Antonio, TX 78229

Mask Fit Locations: there may be a fee for this service. CONCENTRA

Name Address Downtown San Antonio 400 E Quincy St., San Antonio, TX 78215 San Antonio Toepperwein 12702 Toepperwein Suite 120, San Antonio, TX 78233 San Antonio East 3453 North Panam Expy. Ste. 110, San Antonio, TX 78219 San Antonio West Loop 410 7555 NW Loop 410 Ste. 114, San Antonio, TX 78245 Airport San Antonio 10200 Broadway Street Ste. 200, San Antonio, TX 78217 Fiesta Trails 12651 Vance Jackson Road Ste 114, San Antonio, TX 78230


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Tier and Core Requirements

TIER 1

• Online Application & Acknowledgement Card/Addendum (located online) • Photo ID • Confidentiality and Security Agreement (located online) • Job Description • Letter of Compliance (Verification of employment and date of hire)

• Background Check Results for the following:

Performed within 30 days of acct submission If DHP has added San Antonio as a Division and background is from 1-90 days old Healthtrust will accept

however will need a criminal check performed again o Social Security Number Verification o Criminal Search Verification o Violent Sexual Offender o OIG/GSA List of Excluded Individuals o OFAC SDN Search

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

• PPD: o Negative TB Skin Test o Tspot (blood test) or Quantiferon & Questionnaire (no chest x-ray) o If Questionnaire has 2 more Yes responses, must have physician statement to clear

• TDap for Neonatal Photographers only

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TIER 2 & 3

• Online Application & Acknowledgement Card/Addendum (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

• Drug Screen (Amphetamines, Barbiturates, Benzodiazepines, Marijuana, Cocaine, Methadone, Opiates)

• Background Check Results for the following: Performed within 30 days of acct submission If DHP has added San Antonio as a Division and background is from 1-90 days old Healthtrust will accept

however will need a criminal check performed again o Employment History Verification (7 years)

• Be sure to verify term lengths • Example: Scope of Service states one year as IONM. BG must state that title, not Manager in

Intraoperative Services. o Criminal Search Verification (7 years) o Education – per what is requested on the Scope of Service o Social Security Number Verification o Violent Sexual Offender o OIG/GSA List of Excluded Individuals o OFAC SDN Search

• Licensure/Certification Verification [state boards and will be PSV by HWS] (when applicable) • Certificate of Insurance • Flu Vaccine (when applicable) • Annual Credentialing Fee (paid online) • Orientation

• PPD: o Negative TB Skin Test o Tspot (blood test) or Quantiferon & Questionnaire (no chest x-ray) o If Questionnaire has 2 more Yes responses, must have physician statement to clear

• MMR, Varicella and HEP B (Titers acceptable) • TDap for Neonatal Photographers only • N-95 (Aurora 1870+, 3M 1860 Health Care Respirator, 3M 1870+ Health Care Respirator) Mask Fit test

San Antonio has unique exemption forms that must be used when and where appropriate.

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Systems and Process Information

Statuses of Profiles Not Submitted

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

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

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

Incomplete

• 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

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

Ready to Work

• When the DHP’s profile has been reviewed and approved by at least one facility. Compliance

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

• When there is one or more credentials missing or expired in the DHP’s profile. Suspended

• 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

• 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.

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Types of Files/Process Initial File Process: A file that is brand new to the Credentialing Process

• The DHP may not access HCA facilities during the Initial Process • Based on the Classification, Tier & Division of the DHP. Refer to TIER CORE REQUIREMENTS

Added Division File Process: 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. • Documents Required:

o Scope of Service o Vaccines are dependent on the Division

Vendor Change File Process: 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 complete • Additional documents may be requested if they have expired or do not meet our current requirements. • Documents Required: (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) o Letter of Compliance o Competencies/Skills Checklist (Clinical DHPs only) o Scope of Service o Job Description o Certificate of Insurance o Proof of HIPAA Training o Proof of OR Protocol Training o Background Report o Drug Screen Report or Attestation o Alaska Background Check (if applicable) o Garden Park Fingerprint (if applicable)

Reactivation File Process: Applies to files that are currently terminated in StaffPM.

• Must have approval from management before reactivating in StaffPM • File is then reassigned to a credentialing specialist • Must be reviewed in its entirety, similar to an initial

Classification Change Process: Applies to DHPs that are in need of a classification change

• Must have approval from management before changing the classification in StaffPM • Once all required credentials for the new classification have been updated, the DHP can then have access to HCA Facilities

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eSAF Process HealthTrust Workforce Solutions is responsible for… HWS will create the eSAF AD account for DHP’s that need access to facility systems. If systems access is not noted in the eDHP account (the DHP may request systems access via HR/MSO), please have them contact HWS.

Action: • Collecting sensitive demographic information for eSAF access (from eDHP or from DHP) • Verify if DHP is in the eSAF system

o In eSAF – If DHP is in the eSAF system without the correct HWS DHP user type, HWS will contact account manager, modify account once accessible, then notify facilities that will need to grant access.

DHPs may only exist in eSAF in only one Division at a time. Special handling by Division IT will staff be required if multi-division access is required.

o Not in eSAF – HWS will create a profile for the DHP in the eSAF system HWS will receive the DHP’s login and password and pass along to the DHP

• HWS will email the facility contact to confirm the DHP was entered and to have the facility communicate to their designated person to add the systems required (Meditech, Outlook etc.) for that facility.

• Submit an eSAF termination once we receive communication from the HR/MSO contact. o Also, if the individual becomes ineligible, unlicensed, etc. in the future HWS will terminate the DHP

• Any DHP in eSAF with the HealthTrust business unit(03236), must be termed by HealthTrust’s LSCs before we can modify. HealthTrust should reach out to the LSC to request the termination.

HR or MSO is responsible for… HR/MSO needs to determine who will take responsibility for submitting eSAF requests to local IT for specific types of access (Meditech/Outlook/Vitals Now, etc.) based upon the DHP’s role and/or responsibilities. HR/MSO directly assists DHPs that need remote (never enter a facility) access. This type of DHP does not credential with HWS. IMPORTANT: Timely submission of eSAF requests will enable IT&S to setup access prior to the DHP’s first day! Action:

• If applicable -coordinate needed Orientations, etc. • Approve/Deny via eDHP • Coordinate appropriate eSAF access with facility local IT • Reach out to HWS if:

o unable to find user o user’s AD account is termed o user’s AD account is managed by another facility.

• HR/MSO’s will need to communicate to HWS any termination notices in a timely manner (i.e., within 24 hours or by the next business day of the effective date)

Questions: About the HWS DHP process, please contact customer service at 954-414-1440. About eSAF, please contact your local IT&S Service Desk.

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Payments

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 must be made payable to DHP HealthTrust Workforce Solutions, PO BOX 742696, Atlanta, GA 30349

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Contact Information If you have any questions about the application process, please do not hesitate to call or email us. Operating hours are from 7 am to 6 pm, EST.

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 Director, DHP Credentialing P: 954.514.1469 [email protected] Phyona Scarlett Manager, DHP Implementations P: 954.514.1478 [email protected]

Farah Reid Consultant Scope of Service, Implementations P: 954.514.1503 [email protected] Joyce Pietri Training Coordinator and Documentation P: 954.880.6686 [email protected]

DHP OPERATIONS TEAM – CUSTOMER SERVICE Terri Leyva Manager, Customer Service/Hospital & Surgery Center/ Agencies/Quality/New Registrations/eSAF P: 954.514.1435 or Cell: 954.448.1399 [email protected]

DHP PRODUCTION TEAM – CREDENTIALING FILES Geness LeBron Manager, Credentialing Production/Data Entry /Expired Credentials P: 954.514.1548 or Cell: 954.608.1658 [email protected]

Elizabeth Rudd DHP Operations – Hospital/ASD Team Lead Hospital/Surgery Center/Agencies P: 954.514.1429 [email protected]

Diana Velazco-Nunez DHP Production Team Lead P: 954.514.1443 [email protected] Danny Sierra DHP Production Team Lead P: 954.514.3646 [email protected] Eli Johnson DHP Production Team Lead P: 954.514.1269 [email protected]














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