Credentialing

Prior to participating in a health plan's network, physicians and other health care professionals are required to complete the credentialing process. A tremendous amount of time can be spent completing numerous health plan credentialing applications in addition to the supplemental documents that are necessary, i.e. copies of medical liability insurance, medical licenses, etc. An administrative simplification tool for completing and updating one's credentialing and recredentialing applications that may be of interest is described below.

Board Certification

It is important to note that most health plans require as part of their participation criteria that physicians must be board certified or board eligible in their specialty in order to meet credentialing criteria. This accentuates not only the value of board certification in terms of professional competency and knowledge but also how a physician's ability to practice medicine may be adversely impacted without it. Family physicians participating with health plans that require board recertification who fail to recertify could be disaffiliated/dropped from their health plans' network.

The Universal Provider Datasource -- Free, efficient, secure way to complete health plan credentialing and recredentialing applications. Each month, an average of 10,000 new providers are added to the Datasource with the steady increase in the number of participating organizations (i.e. health plans, IPAs, PHOs, hospitals, etc.).