Why is a peer review process required by NCQA during credentialing decisions?

The peer review process is required by the NCQA (National Committee for Quality Assurance) during credentialing decisions primarily to leverage expertise from participating practitioners. This approach ensures that decisions regarding a provider's qualifications, competencies, and overall suitability for the network are informed by knowledgeable practitioners who understand the standards and the specific nuances of practice in the field.

Through peer review, the insights and assessments of experienced colleagues become integral to the credentialing process, allowing for a more thorough and accurate evaluation of individual practitioners. This collaborative assessment helps to identify qualifications that may not be apparent through standard credentialing measures, ensuring that the practitioners who are accredited meet high standards of care and professionalism.

This focus on leveraging expert knowledge is crucial because it contributes to the overall quality of care provided to patients, as practitioners with a deep understanding of the complexities in healthcare can offer valuable perspectives on their peers' capabilities.