Section 965.300  Single Credentialing Cycle

a)         All health care entities and health care plans shall obtain recredentialing data on a health care professional according to the single credentialing cycle, except:

1)         when a health care professional submits initial credentials data to a health care entity or health care plan;

2)         when a health care professional's credentials data change substantively; or

3)         when a health care entity or health care plan requires recredentialing as a result of patient or quality assurance issues.

b)         Data collection for health care entities and health care plans will coincide with a single credentialing cycle that entitles health care entities and health care plans to collect recredentialing data once and not more than every 3 years, except as noted in subsection (a).

c)         Data collection:

1)         will be based on the last digit of each health care professional's Social Security number;

2)         will provide for a one-month notification period for each digit during which each health care entity and health care plan notifies those persons being recredentialed of the time period during which data are expected to be submitted; and

3)         will provide for a two-month collection period for each digit during which each health care entity and health care plan receives data from those persons being recredentialed.

d)         The single credentialing cycle reflects a six-month "OPEN" period when health care entities and health care plans cannot collect data from a health care professional, except as noted in subsection (a).  This period coincides with the Illinois Department of Financial and Professional Regulation's licensing schedule of physicians.

e)         The single credentialing cycle is established as follows:

1)         For the years 2023, 2026, and every third year thereafter

2)         For the years 2024, 2027, and every third year thereafter

3)         For the years 2025, 2028, and every third year thereafter

4)                  For the years 2023, 2026, and every third year thereafter

f)         Once recredentialing is begun in accordance with the single credentialing cycle, a health care entity or health care plan may continue to request data from a health care professional outside of the published single credentialing cycle if it is not submitted by the deadline date published in the schedule.

g)         Nothing in this Section shall be construed to preclude, or otherwise exempt, a health care plan from monitoring, on an ongoing basis, in between recredentialing cycles, information on sanctions, limitations on licensure, and complaints against health care professionals consistent with guidelines issued by any entity that provides private accreditation to health care plans, or from meeting any quality assurance requirement of the entity related to credentialing for the purpose of accreditation or otherwise.

h)         The requirements of this Section apply only to health care plans and health care entities as defined in the Act.

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