Credentialing Application Information
Notification on Provider and Practitioner Credentialing
Credentialing is the important and necessary process of obtaining, verifying and assessing the qualifications of a health care practitioner or provider who will provide patient care services in or for a healthcare organization.
You have the right to review information submitted in support of your credentialing application and to correct erroneous information. You may not review peer review information, peer references, and other peer-review protected materials. You also have the right, upon request to be informed of the status of your credentialing or recredentialing application.
During the credentials verification process discrepancies are sometimes identified between the information that you submit and that which we receive from primary and other outside sources. When this happens you will be notified and told about the discrepancy. You may provide additional information, as appropriate and desired. Credentialing staff document the date of receipt of the information from you and it is included with your application. This additional information is included with the documents that our Credentialing Committee reviews to render its decision about participation in our Network.
If information we receive from outside sources is different from that which you have provided, you will be notified and told about the difference. You may correct erroneous information submitted by another source. The correction must be written and sent to the Credentialing Department within 30 calendar days from the date of notification. Your written correction will be included with the documents that our Credentialing Committee reviews to render its decision about participation in our Network.
You may review information we obtain to evaluate your application, CV, attestation or other documents. This includes information from outside sources such as state licensing boards. You may not review peer review protected information. If you wish to review this information, please contact the Credentialing Department at the telephone number below to arrange the process. If you would like to know the status of your application, please contact our Credentialing Staff at the telephone number below to request information. Our Credentialing staff can tell you when your application will be reviewed by the Credentialing Committee; whether or not there are outstanding issues; or answer any questions you may have about your application or our credentialing processes.
You must be fully credentialed and contracted before providing covered services to our members. This includes new practitioners who are joining an already credentialed group practice. Our credentialing application and instructions are available via our website or by contacting our Contracting Department.
To contract with Behavioral Health Professionals, Inc., you must complete our credentialing process and be approved by our Credentialing Committee. We will notify you in writing within 60 calendar days of the Credentialing Committee’s decision. Once the contract is finalized and credentialing approval is complete we will notify you when you may begin providing covered services to our members.
You must be re-credentialed at least every three years. Among other things we assess the following:
- Outcomes from patient complaints
- Quality improvement activities
- Member Satisfaction
Other quality measures may be adopted by us as well. We may also initiate a facility or medical record audit at any time based on patient complaints or other concerns that may arise. As part of the review, we conduct periodic medical record audits of all providers to ensure compliance with internal and external requirements and protocols.