Provider Credentialing: Committee Files Backed by Verified Evidence

Five checks per provider and evidence in two different places

Under the office's credentialing policy, each application stands on five checks. The state license has to be active and unrestricted where the provider will practice, the DEA registration has to be current and registered in that state, malpractice coverage has to meet the policy limits, the background check has to come back clear, and board certification has to be confirmed by the board itself. A file missing any one of them is not ready for committee.

The license verifications, DEA certificates, insurance face sheets and background results are filed in Box. Board certification replies arrive as messages in the verification mailbox in Outlook. Application status lives in Salesforce, and the committee summary is a document in Drive that a specialist assembles by hand. When a batch of board replies lands the week before committee, someone re-reads every affected file and edits the summary line by line.

Who works in the room

Evidence questions land with Ryan even when they name no one. Ryan is the room's default agent and the only agent with a grant to the verification mailbox, which the credentialing manager approved. Myco picks up when the work is auditing someone's draft or asking a provider for a missing document. When Ryan finishes a re-run, it opens a thread for Myco whose first message lists the changed applications and the check that moved each one, and Myco audits those lines before the manager sees them.

A committee batch, file by file

The credentialing policy is in Drive and its five checks are in the room guidelines. Nothing reaches the committee or a provider without a person.

When the evidence or the applicants change before committee

Some changes are new evidence. A batch of board replies arrives in Outlook and clears four pended files. Others change the rules. A notice that a state has been admitted to a licensure compact changes which licenses the policy accepts for that state, so every application whose eligibility hinged on license state is re-run against all five checks, not just the license line. Ryan re-runs the full rule set for those files and notes which check moved each one.

Withdrawals look smaller than they are. When two providers withdraw, their files come out of the batch and the committee summary, and the specialty counts change. Myco re-audits the summary after every re-run, so the version the chair receives matches Salesforce on the day of committee. Every agent turn that read or wrote a record keeps its run history, which the manager can open when someone asks how a file was decided. An automation flags any application whose license or DEA expiry date passes before committee.

What the checks catch

• A drafted approval that rests on the provider's own statement of board certification, with no reply from the board in the mailbox
• A DEA registration that expired between application and committee, or that is registered in a different state
• A compact admission applied to the license check alone, without re-running the other four checks
• A withdrawn provider still listed in the committee summary or counted in the specialty totals

What stays with people

• Approving each disposition before Salesforce is updated
• Deciding every file referred for committee review, such as a malpractice claim or a background flag
• Pressing Send on each request to a provider or a board, drafted by Myco in Gmail
• Signing the per-specialty close-out

Integrations in this workflow

Kylon is not a credentialing verification system, and it does not stand in for one. The files, the mailbox and the application records stay where they are, and Kylon holds the coordination between them.

• Box
• Gmail
• Google Drive
• Outlook
• Salesforce
• Slack

• Salesforce holds each application with its specialty, status and disposition
• Box holds the license, DEA, malpractice and background check files
• Outlook is the verification mailbox where board certification replies arrive
• Gmail carries requests for missing documents, each one a draft a specialist sends
• Google Drive keeps the credentialing policy, the drafted batch and the committee summary
• Slack is where specialists outside the room post updates from boards and providers

Where to start

Use one committee batch as the first cycle. Connect the Salesforce object that holds applications, grant Ryan access to the verification mailbox, and write the one rule in the room guidelines: no application is proposed as clean unless all five checks are verified at the source, and the manager approves every disposition before it is written.

“A file goes to committee when the evidence says it is ready, not when the calendar does.”

Set it up with your agent

Open a new Room, add your agent and paste this prompt. It connects the tools, builds the App with you and asks for your rules one step at a time, and nothing goes out until a person approves it.