Illinois Administrative Code › Title 77 - PUBLIC HEALTH › Part 965 - HEALTH CARE PROFESSIONAL CREDENTIALS DATA COLLECTION CODE › Subpart A - GENERAL › Section 965.110 - Definitions

Current through Register Vol. 48, No. 28, July 12, 2024
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)
Single credentialing cycle - a process 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)
Recredentialing - the process 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 no more than once every 2 years. (Section 5 of
				  the Act)