Please complete and submit the Peer Reviewer Application. If your credential is not an MD, DO, DPM, DOC or other physician, please complete the Health Care Professional Other than Physician (HCPOTP) Application.
Credentialing – We Verify our Peer Reviewers’ Credentials
Credentials verification serves three functions:
- Initial credentialing is the evaluation of an individual’s application for participation on the KFMC panel of Peer Reviewers (PRs).
- Re-credentialing/re-verification assesses the individual reviewer’s qualifications for continued participation as a Reviewer.
- Ongoing monitoring of license and certification actions, as well as sanctions or disciplinary actions, assures that only those reviewers meeting the program requirements will provide review services.
Annually KFMC will verify your licensure within your area of practice. Every three years, KFMC will update self-reported information as in the initial application form and require new attestations.
Training material is contained in the Peer Reviewer Orientation Manual. With your application, you will return an attestation indicating that you have reviewed and understand the document.
Please pay close attention to the training section titled “Roles and Responsibilities of a Peer Reviewer.”
Credential Status Changes
Credential status changes will usually be captured in reports addressing licensure or certification status; however, some will be self-reported. Consistent with the policy of maintaining a panel of qualified reviewers, KFMC PRs must notify us within three business days of any adverse change in licensure or certification status. IR 3(a) Adverse changes include not only loss of a license or board certification, but also any sanction or disciplinary action related to their credentials and loss of hospital privileges or pending hospital action. Notice of an adverse change can be provided in any form i.e. written, phone call, fax.
An adverse change in licensure, certification, or sanction/disciplinary action is treated as any other piece of confidential information. Reviewers who are levied with an adverse change of this nature are considered out of compliance with qualifications to participate as a Reviewer with KFMC.
A copy of the form, Self-Reported Adverse Change in Licensure, Certification or Sanction and Disciplinary Action, is provided with the application.
Peer Reviewers are reimbursed at an hourly rate for the actual time reviewing a medical record. We must have a current W-9 for you on file.
Conflict of Interest
With your application to be a Peer Reviewer, you must complete and return a detailed Conflict of Interest form. If you have any questions regarding a potential or actual conflict of interest, do not hesitate to contact Michelle Sigmund, KFMC’s Director of Clinical Care Review & Quality Improvement, at 800-432-0770.
If you become a Peer Reviewer, you will have to complete and return another Conflict of Interest attestation form with every case you review. This action is both a reminder and a confirmation that to your knowledge, you have no potential or actual conflict to provide an unbiased, professional review on each case in hand.
Some very basic Conflict of Interest examples would be:
- Previous involvement in the case,
- Association with the hospital at which the care was provided,
- Prior conflict with the physician involved,
- Affiliation with the physician involved in the care,
- You are in economic competition with the physician involved.
For more information, call Michelle Sigmund at 800-432-0770 or contact us by email.