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US News/NCQA

Last Updated: June 27, 2006

Practitioner Credentialing

Please note that as a practitioner, you have the right to:

  • review information submitted to support your credentialing application,
  • correct erroneous information, and
  • be informed of the status of your credentialing or recredentialing application upon request.

Recredentialing Process

Below is an outline of our recredentialing process, along with Care Choices and provider responsibilities.

Care Choices Responsibility Provider Responsibility
Send initial written request to provider with:
  • Recredentialing form
  • List of required documentation
  • Complete recredentialing form and submit required documentation within 30 days of receipt of the letter.
    If provider does not submit information within 30 days
    Send second written request to provider with:
  • Recredentialing form
  • List of required documentation
  • Complete recredentialing form and submit required documentation within 10 daysof receipt of the letter.
    If provider does not submit information within 10 days of second request
    Send third written request to provider with:
  • Recredentialing form
  • List of required documentation
  • Complete recredentialing form and submit required documentation within 10 daysof receipt of the letter.

    Note: If provider does not respond to the third written request within 10 days of receipt of the letter, it will be assumed that the provider no longer wants to participate with Care Choices HMO and will be terminated.

    After provider information is received by Care Choices

    Verify State/Federal licensure status and hospital affiliation status. Query the National Practitioner Data Bank and Healthcare Integrity and Protection Databank. Results of continued participation status will be communicated to the provider upon completion.