Section 965.110  Definitions

Act – the Health Care Professional Credentials Data Collection Act [410 ILCS 517].

Credentialing – the process of assessing and validating the qualifications of a health care professional.  (Section 5 of the Act)

Credentials data – those data, information, or answers to questions required by a health care entity, health care plan, or hospital to complete the credentialing or recredentialing of a health care professional.  (Section 5 of the Act)

Health care entity – any of the following entities that require the submission of credentials data in order for a health care professional to participate or provide care as a part of, or in conjunction with, the health care entity:

a health care facility or other health care organization licensed or certified to provide medical or health services in Illinois, other than a hospital;

a health care professional partnership, corporation, limited liability company, professional services corporation or group practice; or

an independent practice association or physician hospital organization. (Section 5 of the Act)

Entities licensed under other Acts that conduct credentialing in order for a health care professional to provide services, such as home health agencies, hospices, post-surgical recovery care centers, and ambulatory surgical treatment centers, are health care entities for the purposes of this Part.  Providers certified under the federal Medicare Program, such as Rural Health Clinics and End Stage Renal Disease treatment facilities, are also health care entities under this Part if they credential providers in order to provide services in their facilities/programs.

Health care plan – any entity licensed by the Department of Insurance as a prepaid health care plan or health maintenance organization or as an insurer that requires the submission of credentials data.  (Section 5 of the Act)

Health care professional – any person licensed under the Medical Practice Act of 1987 or any person licensed under any other Act subsequently made subject to the Act. (Section 5 of the Act)

Hospital – a hospital licensed under the Hospital Licensing Act or any hospital organized under the University of Illinois Hospital Act.  (Section 5 of the Act)

Recredentialing – a process undertaken for a period not to exceed 3 years by which a health care entity, health care plan, or hospital ensures that a health care professional who is currently credentialed by the health care entity, health care plan, or hospital continues to meet the credentialing criteria used by the health care entity, health care plan, or hospital. (Section 5 of the Act)

Single credentialing cycle – a process undertaken for a period not to exceed 3 years whereby for purposes of recredentialing, each health care professional's credentials data are collected by all health care entities and health care plans during the same time period. (Section 5 of the Act)

Uniform health care credentials form – the form referenced in Section 965.Appendix A to collect the credentials data commonly requested by health care entities and health care plans for purposes of credentialing. (Section 5 of the Act)

Uniform health care recredentials form – the form referenced in Section 965.Appendix B to collect the credentials data commonly requested by health care entities and health care plans for purposes of recredentialing. (Section 5 of the Act)

Uniform hospital credentials form – the form referenced in Section 965.Appendix A to collect the credentials data commonly requested by hospitals for purposes of credentialing. (Section 5 of the Act)

Uniform hospital recredentials form – the form referenced in Section 965.Appendix B to collect the credentials data commonly requested by hospitals for purposes of recredentialing. (Section 5 of the Act)

Uniform updating form – the standardized form referenced in Section 965.Appendix C for reporting of corrections, updates, and modifications to credentials data to health care entities, health care plans, and hospitals when those data change following credentialing or recredentialing of a health care professional. (Section 5 of the Act)

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