Flag Management Guide: Actions & Ownership
Understand who owns which actions when it comes to flag resolution. This guide breaks down the expected responsibilities across customer-facing and internal flags
Overview
This section defines the flag types, expected actions, classified by customer and Certify. It addresses the separation between internal review flags (handled by Certify teams) and
Customer-facing flags (requiring Customer decision-making).
Customer-Facing Flags (Flags Dashboard)
- Action Owner - Provisional approver on the customer side
|
Data Section |
Flag Type |
Recommended Action |
|
State Licenses |
Expired |
Practitioner to be terminated if license not renewed within 30 days |
|
State Licenses |
Expiring Soon |
Clear the Flag. Practitioner to be terminated if license not renewed within 30 days after expiry |
|
State Licenses |
License Action Found |
Escalate Credentialing Committee. May require termination depending on severity |
|
State Licensure Actions |
License Action Found |
Escalate to the Credentialing Committee for decision. |
|
NPDB Reports |
NPDB Action Found |
Escalate to the Credentialing Committee for decision. |
|
OIG Exclusions |
Sanction Found |
Terminate the practitioner |
|
SAM Exclusions |
Sanction Found |
Terminate the practitioner |
|
State Medicaid Exclusions |
Sanction Found |
Terminate the practitioner |
|
Medicare Opt-Outs |
Sanction Found |
Mark the flag as Seen |
|
CMS Preclusions |
Sanction Found |
Terminate Provider |
|
NPI |
NPI Invalid |
Escalate to the Credentialing Committee. Terminate if not updated within 30 days from date of flag |
|
DEA Licenses |
Expired |
Escalate to the Credentialing Committee. |
|
DEA Licenses |
Expiring Soon |
Mark the flag as seen. Escalate to the Credentialing Committee if the license not renewed within 30 days after expiry |
|
CDS Licenses |
Expired |
Escalate to Credentialing Committee |
|
CDS Licenses |
Expiring Soon |
Mark the flag as Seen |
|
Malpractice Insurance |
Expired |
Mark the flag as Seen |
|
Malpractice Insurance |
Expiring Soon |
Mark the flag as Seen |
|
Death Information |
Provider Deceased |
Terminate the practitioner |
|
OFAC Sanctions |
Sanction Found |
Terminate the practitioner |
|
Education & Training |
Employment Gap Without Explanation |
Escalate to the Credentialing Committee |
|
Disclosure Questions |
Disclosure Question Answered Unfavorably |
Escalate to the Credentialing Committee |
Internal Data Quality Flags
- Action Owner - Certify Operations Team
The below actions are meant for Certify internal teams only.
|
Data Type |
Flag Type |
Expected Action |
|
All |
Missing Data |
Research and populate missing license information |
|
All |
Duplicate Records |
Resolve duplicate licenses using uniqueness rules (state, normalized license number, type). Clear flag if invalid |
|
State License |
Secondary Source State License |
Verify license from primary source website and update the “Source”. Saving then will clear the flag. |
|
Board Certifications |
No Expiration Date |
“Clear” if invalid (e.g. MOC) |