Credentialing & Contracting

Credentialing and Contracting

Credentialing is the process of obtaining and reviewing a clinicians documentation to determine a status of participation privilege in a health plan. Documentation should be provided by the applicant and must include their education, clinical privileges, accreditation, certifications, professional liability insurance, malpractice history and professional competence.

To become credentialed for the first time, you will provide:

· Attestation, signature and date

· Curriculum Vitae

· Work history (month/year format)

· Copy of DEA and/or CDS certificate

· Copy of malpractice insurance

· Summary of pending or settled malpractice cases if applicable

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Contracting

Additional Information

 

  • Team coordination to improve access and quality of care for patients at any of the health centers.
  • Efficient methods of communication, including daily hospitalization reports.
  • Ensure follow-up of patients after hospitalization.
  • Quality control in patients care, of all age groups and stages of development.
  • Prepare, special reports and analyzes, upon request.
  • Track, monitor, and actively manage assigned patient cases to ensure coordination of care, retention of patient and a high level of utilization.
  • Retrieve all elements to build a patient’s longitudinal care record.
  • Interact with patient’s physicians and other staff both within the clinic and outside facilities providing accurate, timely and responsive information.

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