Credentialing
Credentialing plays an important role in relationships with contracted providers
The credentialing department evaluates the qualifications of providers who wish to become affiliated with Network Health. The credentialing process plays a vital role in providing safe, quality patient care to our members.
Policies and Procedures
Availability of Provider Directories Changes
Clinician Data Maintenance and Credentialing Requirements
Credentialing Committee Membership and Responsibility (n00259)
Credentialing Process Policy (n00198)
Credentials Information Collection, Coordination and Dissemination
Delegation and Oversight Policy and Procedure (n00329)
Delegation and Oversight Policy and Procedure (n05019)
Fair Hearing and Appellate Review Process
Initial and Ongoing Assessment of Organizational Providers
Medicare Opt Out
Process of Ongoing Monitoring of Sanction, Complaints, Adverse Events and Quality Issues
Provider Data Validation
Provider Directory Compliance
Range of Actions to Improve Performance/Altering the Conditions of Participation
Recredentialing Process Policy
Recredentials Information Collection, Coordination and Dissemination
Report to Proper Authorities
Site Visit and Medical Record Keeping Practices
Contact Information
Phone: 920-720-1790 or 844-295-9214
Fax: 920-720-1853