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CCPP Certification Program
Module 7: Credentialing, Privileging, and Malpractice Setup
Building the Professional Framework for Legitimate, Billable, and Protected Practice.
From Practitioner to Provider: The Architecture of Professional Legitimacy
Throughout your career, your professional legitimacy has been defined by two core documents: your diploma from an accredited college of pharmacy and your license to practice from the state board. These have been the keys that unlock your ability to function as a pharmacist. As you transition into a collaborative practice role, however, a new and far more complex layer of professional validation is required. You are moving from being a licensed practitioner to becoming a recognized provider within the healthcare system.
This transition requires the construction of a robust professional architecture around your existing license. This architecture is built through the meticulous, often bureaucratic, processes of credentialing, privileging, and enrollment. These are not mere administrative hurdles; they are the formal mechanisms by which healthcare organizations and payers grant you the authority to practice, the ability to bill for your services, and the trust to care for their patients. To a physician, these processes are a standard part of their career. For a pharmacist, they represent a new and often intimidating frontier.
This module is your comprehensive guide to navigating this frontier. We will demystify the alphabet soup of NPIs, CAQH, and payer enrollment. We will provide a step-by-step masterclass in building a professional portfolio that meets the exacting standards of credentialing committees and a deep dive into securing the clinical privileges that define your scope of practice within an organization. Finally, we will address the critical component of professional protection: malpractice insurance. Mastering this material is the final step in solidifying your role as an autonomous, respected, and indispensable member of the healthcare team.
Your Roadmap to Becoming a Recognized Provider
This module will equip you with the practical, step-by-step knowledge to build the official framework that underpins a successful collaborative practice.
Obtaining an NPI and CAQH Registration
A foundational lesson on securing your unique National Provider Identifier (NPI) and building your universal credentialing profile in the CAQH ProView® system, the industry standard for provider data collection.
Credentialing with Payers and Medical Groups
A detailed walkthrough of the payer enrollment process. Learn how to become a credentialed provider with Medicare, Medicaid, and commercial insurance plans, a critical step for generating billable revenue.
Privileging within Health Systems and Clinics
An in-depth guide to the process of obtaining clinical privileges, from defining your requested scope of practice in a “delineation of privileges” form to navigating the medical staff credentialing committee.
Professional Liability and Malpractice Coverage
A practical masterclass on pharmacist-specific professional liability insurance. We will explore the types of coverage, typical limits, and how to ensure you are adequately protected as you practice in an expanded role.
Maintaining Active Credentials and Renewals
An exploration of the ongoing responsibilities of a credentialed provider, including the re-credentialing process, CAQH re-attestation, and the importance of meticulous record-keeping for all licenses and certifications.
