YM Credentialing

The Credentialing department of Yale Medicine is responsible for review and verification of information collected from a health care provider who is interested in peer review and acceptance into the YM Clinical Practice and in participating with managed care organizations. The YM credentialing program supports the development and maintenance of credentialing and re-credentialing standards in accordance with the National Committee for Quality Assurance (NCQA) requirements, and ensures that members who seek care from Yale Medicine have adequate access to a qualified provider. 

The Credentialing staff collects required documentation and completes provider files, including but not limited to: obtaining primary source verifications of medical and professional licenses, medical education, residency, hospital privileges, board certification or eligibility, professional liability policy history and any applicable disciplinary actions. Secondary source verifications include obtaining copies of the provider's medical and/or professional license(s), DEA/State Controlled Substance certificates, professional liability coverage certificate and Curriculum Vitae and Work History (if applicable). Each provider must also submit a completed Universal Credentialing Application (UCA) and supportive documentation.

Application

UCS

Physicians must be credentialed to be reimbursed for services.

Several plans have “delegated” the duties of credentialing to the YM. To be reimbursed for services through these plans, you must complete the UCA.