Providers must meet credentialing criteria to become a network provider. These criteria include:
|Item||Description||Source||Frequency of Validation||Limitations (If Any)|
|Practitioner Name||Practitioner||Every 3 Years. Upon notification from Practitioner when changing a name.||None|
Every 3 Years. Upon notification from Practitioner when updating information.
|Specialty||The type of care or conditions a practitioner specializes in, such as family||Practitioner||Every 3 years. Upon notification from Practitioner when adding or changing a specialty.||None|
|Medical Group Affiliations||
The organizations, companies or medical groups the practitioner is employed by or associated with. An organization or group may have more than one care site.
|Practitioner||Every 3 years. Upon notification from Practitioner when adding or changing a medical group affiliation.||None|
|Hospital Affiliations||The hospitals where a practitioner is allowed to admit and care for patients.||Practitioner||Every 3 years. Upon notification from Practitioner when adding or changing a hospital affiliation.||None|
|Hospital Name and Location||None|
|Hospital Accreditation||An independent accreditation organization has recognized a hospital as meeting predetermined standards for quality of care and service. Two examples are the Joint Commission on Accreditation of Healthcare Organizations (Joint Commission) and National Integrated Accreditation for Healthcare Organizations (NIAHO).||Provider||Every 3 years. Upon notification from Provider when recertifying, adding or changing an accreditation.||None|
|Board Certification||Board certification involves rigorous testing by a recognized board of the American Board of Medical Specialties and is not required by most states. To verify a provider's board certification and status, visit the American Board of Medical Specialties||Practitioner||Every 3 years. Upon notification from Provider when renewing, adding or changing a board certification. Quarterly review of expired boards.||None|
|Accepting New Patients?||Indicates whether a primary care practitioner or personal physician is accepting new patients. A practitioner may have a full patient roster and cannot accept any new patients at this time.||Practitioner||Every 3 years. Upon notification from Provider when adding or changing practice language information.||None|
|Languages Spoken||Languages, in addition to English, spoken by the practitioner and/or staff.||Practitioner||Every 3 years. Upon notification from Provider when adding or changing practice language information.||None|