Validation of Information

Validation of Information

Physician Information

Notes

  • The term doctor, physician, provider and practitioner are used interchangeably in this section.

Name

  • Source: The practitioner's initial credentialing application.
  • Frequency of validation: Verified at initial credentialing and re-credentialing, every 3 years.
  • Limitations: Self-reported information.

Gender

  • Source: The practitioner's initial credentialing application.
  • Frequency of validation: Verified at initial credentialing and re-credentialing, every 3 years.
  • Limitations: Self-reported information.

Specialty

  • Explanation: A focused area of medicine that a doctor / provider has additional education and training beyond a general medical license. See Specialty definitions
  • Source: The practitioner's initial credentialing application. It is verified by checking with the American Medical Association (AMA) or American Osteopathic Association (AOA) for board-certified physicians or through primary source verification from the specialty training school.
  • Frequency of validation: Verified at initial credentialing and re-credentialing, every 3 years.
  • Limitations: None

Specialty

  • Explanation: A focused area of medicine that a doctor / provider has additional education and training beyond a general medical license. See Specialty definitions
  • Source: The practitioner's initial credentialing application. It is verified by checking with the American Medical Association (AMA) or American Osteopathic Association (AOA) for board-certified physicians or through primary source verification from the specialty training school.
  • Frequency of validation: Verified at initial credentialing and re-credentialing, every 3 years.
  • Limitations: None

Hospital Affiliations

  • Explanation: The facility (hospital) where he/she has admitting privileges.
  • Source: The practitioner's initial credentialing application with written validation from the listed facility.
  • Frequency of validation: Verified at initial credentialing and re-credentialing, every 3 years.
  • Limitations: Self-reported information.

Medical Group Affiliations

  • Explanation: Two or more providers that work together in the same office.
  • Source: The practitioner's initial credentialing application.
  • Frequency of validation: Verified at initial credentialing and re-credentialing, every 3 years. Also updated when provided with written notification by the practitioner that he/she is moving or adding a medical group affiliation.
  • Limitations: Self-reported information.

Board Certification

  • Explanation: Recognizes a doctor has met the requirements/standards of a nationally recognized specialty organization.
  • Source: The practitioner's initial credentialing application and verified through the American Board of Medical Specialties (ABMS), the American Medical Association (AMA), or the American Osteopathic Association (AOA).
  • Frequency of validation: Verified at of initial credentialing and re-credentialing, every 3 years.
  • Limitations: None

Accepting New Patients

  • Explanation: The provider will see new patients.
  • Source: The practitioner's initial credentialing application and updated as reported by practitioner.
  • Frequency of validation: Verified at initial credentialing and updated when notified by the practitioner.
  • Limitations: Self-reported information and requires written notification of change from the practitioner.

Language spoken by the Practitioner, or Clinical Staff

  • Explanation: This is the language(s) spoken by the practitioner or clinical office staff.
  • Source: The practitioner's initial credentialing application.
  • Frequency of validation: Obtained at initial credentialing and updated when notified by the practitioner.
  • Limitations: Self-reported information.

*TRUSTED Health Plan offers telephonic interpretation services to all members and provider offices.

Office Location

  • Source: The practitioner's initial credentialing application.
  • Frequency of validation: Verified at initial credentialing and re-credentialing, every 3 years. Also updated when notified in writing by the practitioner that he/she is moving.
  • Limitations: Self-reported information.

Hospital Information

  • Source: Initial contract request.
  • Frequency of validation: Verified upon contract initiation and every 3 years. Also updated when notified in writing of any changes (within 30 days).
  • Limitations: Self-reported information.

Location

  • Source: The hospital’s initial contract request.
  • Frequency of validation: Verified upon contract initiation and every 3 years. Also updated when notified in writing of any changes (within 30 days).
  • Limitations: Self-reported information.

Accreditation

  • Explanation: Certification that a hospital has met the requirements/standards of a nationally recognized accrediting body for hospitals, such as The Joint Commission.
  • Source: Verified directly with the accrediting body.
  • Frequency of validation: Verified upon contract initiation and every 3 years.
  • Limitations: None

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