11 Credentialing
11 Credentialing
Credentialing refers to a process performed by IntegraNet to verify and confirm that an applicant (physician and/or other provider type) meets the established policy standards and qualifications for consideration in the IntegraNet Provider Network. Upon completion of the credentialing process, each applicant is presented to the Credentialing Committee, which is comprised of physicians in various specialties, for review and recommendation. Initial credentialing is performed when an application is received. Recredentialing is conducted at least every three (3) years thereafter or as otherwise required by state regulations and at the discretion of IntegraNet.
Required supporting documentation must be submitted with each credentialing application. Such documentation may include, but is not limited to: licensure, education, training, clinical privileges, work history, accreditation, certifications, professional liability insurance, malpractice history, professional competency. Documentation submitted by an applicant and/or Providers’ s office is verified for accuracy and completeness. At the discretion of IntegraNet an applicant may be required to submit additional information.
IntegraNet recognizes a Provider’s right to review information submitted in support of his/her credentialing application to the extent permitted by law and to correct erroneous information. At any time during the credentialing process a Provider may request the status of his/her application by contacting the IntegraNet Credentialing Department. That fact that a Provider is credentialed is not intended to guarantee or promise of any level of care or service.
The credentialing summary, criteria, standards, and requirements set forth herein are not intended to limit IntegraNet discretion in any way to amend, change or suspend any aspect of its credentialing program nor is it intended to create rights on the part of practitioners who seek to provide health care services. IntegraNet further retains the right to approve, suspend, or terminate individual physicians and health care professional, and sites in those instances where it has delegated credentialing decision making.
IntegraNet Health does not subdelegate credentialing.