AMA Credentialing Products and Services Measured Against Regulatory and Accreditation Standards
AMA PHYSICIAN PROFILE (MD and DO)
Hospital Setting |
Managed Care |
AAAHC |
|||||||
Credentials Element |
Source |
CMS |
TJC |
HFAP |
DNV |
CMS |
NCQA |
||
Licensure: Current |
State licensing board |
✓ |
✓(1) |
✓(2) |
✓ |
(3) |
(3) |
✓ |
|
Licensure: Historical |
State licensing board |
+ |
+(1) |
✓(2) |
+ |
+ |
+ |
+ |
|
US education |
AAMC and osteopathic schools |
✓ |
✓ |
✓ |
✓ |
✓ |
✓ |
✓ |
|
ACGME-accredited training |
ACGME-accredited programs |
✓ |
✓ |
✓ |
✓ |
✓ |
✓ |
✓ |
|
ABMS board certification |
ABMS |
+ |
+ |
✓ |
+ |
✓ |
✓ |
✓ |
|
NPI number |
CMS NPPES |
+ |
+(1) |
+ |
+ |
+ |
+ |
+ |
|
DEA registration |
DEA |
+ |
+(1) |
✓ |
✓ |
✓ |
✓ |
✓ |
|
SANCTION ALERTS* |
Licensure: Current |
State licensing board |
+ |
✓(1) |
✓(2) |
✓ |
(3) |
(3) |
+ |
Licensure: Historical |
State licensing board |
+ |
+(1) |
✓(2) |
+ |
(3) |
(3) |
+ |
|
Medicare/Medicaid |
OIG |
+ |
+(1) |
✓ |
+ |
✓ |
✓ |
+ |
|
ECFMG identification number |
ECFMG |
AMA provides the number only. |
CONTINUOUS MONITORING SERVICE OF PHYSICIAN PROFILES
Hospital Setting |
Managed Care |
AAAHC |
|||||||
Sections Monitored on an Ongoing Basis |
Update Notification Trigger |
CMS |
TJC |
HFAP |
DNV |
CMS |
NCQA |
||
SANCTION ALERTS* |
Licensure: Current and historical |
Alert from state licensing board |
+ |
+(1) |
+ |
+ |
(3) |
(3) |
+ |
Medicare/Medicaid |
Alert from OIG |
+ |
+(1) |
+ |
+ |
✓ |
✓ |
+ |
|
Licensure |
Changes in:
|
✓ |
✓ |
✓ |
✓ |
+ |
+ |
+ |
|
NPI number |
Changes in:
|
+ |
+ |
+ |
+ |
+ |
+ |
+ |
|
DEA registration |
Changes in:
|
+ |
+ |
✓ |
+ |
+ |
+ |
+ |
|
ABMS board certification |
Changes in:
|
+ |
+ |
+ |
+ |
+ |
+ |
+ |
|
ACGME-accredited training |
Changes in:
|
+ |
+ |
+ |
+ |
+ |
+ |
+ |
|
US education |
Changes in:
|
+ |
+ |
+ |
+ |
+ |
+ |
+ |
Information current as of Aug. 11, 2021. ©2021 American Medical Association. All rights reserved.
Download an important file containing acceptance of AMA Physician Masterfile data from TJC, NCQA, and AAAHC as well as an ABMS statement on AMA as an official display agent.
Symbols
✓ = meets standards
+ = exceeds standards through higher level of compliance or industry leading practice
Table Footnotes
* Sanction Alerts: AMA provides notification only of sanctions in the profile’s “Action Notifications” section. Contact the primary source directly for sanction details.
(1) Per The Joint Commission’s 10 credentials verification organization guidelines
(2) HFAP requires primary source verification of licensure but additionally requires a query of the National Practitioner Data Bank and of the Federation of State Medical Boards or the Fraud and Abuse Control Information System.
(3) NCQA and CMS for Medicare Advantage require primary source verification of license directly with the licensing board and license sanctions directly with the licensing board or other recognized source.
Acronyms
AAAHC = Accreditation Association for Ambulatory Health Care, Inc.
AAMC = Association of American Medical Colleges
ABMS = American Board of Medical Specialties
AMA = American Medical Association
AOA = American Osteopathic Association
CMS for hospital setting = Centers for Medicare & Medicaid Services: Conditions of Participation for Hospitals
CMS for managed care setting = Centers for Medicare and Medicaid Services: Medicare Advantage
DEA = Drug Enforcement Administration
DNV = DNV Healthcare
ECFMG = Educational Commission for Foreign Medical Graduates
HFAP = Healthcare Facilities Accreditation Program
NCQA = National Committee for Quality Assurance
OIG = Office of Inspector General