Section 965.130  Use of Uniform Credentialing Forms

a)         A health care entity, a health care plan, or a hospital may accept or require credentialing data in an electronic format provided it contains the required content prescribed by the Department in Sections 965.APPENDIX A through C.

b)         All health care entities, health care plans, and hospitals that credential health care professionals shall only require the submission of the following forms, as specified in Section 15 of the Act:

1)         For credentialing, the Uniform Health Care and Hospital Credentials Form (Section 965.Appendix A);

2)         For recredentialing, the Uniform Health Care and Hospital Recredentials Form (Section 965.Appendix B);

3)         For updating credentials information, the Uniform Updating Form (Section 965.Appendix C);

4)         Any additional credentials data requested; and

5)         An online credential with required content as required by forms under this Section.

c)         This Section does not prohibit or restrict the right of any health care entity, health care plan or hospital to request additional information necessary for credentialing or recredentialing.  (Section 15(i) of the Act) Nothing in this Part prohibits a pre-application process from being in place at a health care entity, health care plan, or hospital.  Individual attestation and release forms may be unique to each health care plan, hospital, or health care entity as a part of the credentialing or recredentialing process.

d)         Nothing in the Act or this Part requires a health care entity, health care plan, or hospital to seek all of the credentials data that may be provided in the mandated credentials data gathering forms.  The extent to which a health care entity, health care plan, or hospital requires a health care professional to complete the applicable sections of the forms is within the discretion of the health care entity, health care plan, or hospital.  However, no health care entity, health care plan, or hospital may reject or deny a form that includes more information than the requirements of the individual health care entity, health care plan, or hospital.

e)         Each health care professional shall provide any corrections, updates, and modifications to their credentials data to ensure that all credentials data on the health care professional remains current.  Any corrections, updates, and modifications shall be provided to the health care entity, health care plan or hospital that collects the health care professional's credentials data in accordance with the following time frames:

1)         Within 5 business days for state health care professional license revocation, federal Drug Enforcement Agency license revocation, Medicare or Medicaid sanctions, revocation of hospital privileges, any lapse in professional liability coverage required by a health care entity, health care plan or hospital, or conviction of a felony.

2)         Within 45 days for any other change in the information from the date the health care professional knew of the change.  (Section 15(g) of the Act)

f)         All updates shall be made on the updating forms in Section 965.Appendix C. (Section 15(g) of the Act) Updated information will be based on the information submitted to a health care plan, health care entity or hospital in the form in Section 965.Appendix B.

g)         Collection of the information contained in the forms under this Part does not require health care entities, health care plans or hospitals to use all the data and fields in the credentialing process. Nothing in the Act or this Part mandates whether or how credentials data must be verified or assessed as part of the credentialing process.  All decisions about whether and how to verify and assess any or all the credentials data submitted to a health care entity, health care plan or hospital by a health care professional is exclusively within the lawful discretion of the health care entity, health care plan, or hospital that is credentialing that health care professional.

h)         Nothing in the Act or this Part prohibits a hospital from granting disaster privileges pursuant to the provisions of Section 10.4 of the Hospital Licensing Act.  When a hospital grants disaster privileges pursuant to Section 10.4 of the Hospital Licensing Act, that hospital is not required to collect credentials data pursuant to the Act.  (Section 15(m) of the Act)

(Source:  Amended at 48 Ill. Reg. 12398, effective August 1, 2024)