Credentialing Process
Our credentialing policies and procedures incorporate current NCQA standards and guidelines, as well as applicable state and federal requirements. Each contracted provider agrees to submit all requested information necessary to credential or recredential in accordance with these policies. The practitioner, must complete either the Council for Affordable Quality Healthcare (CAQH) application or the INTotal Health application form when seeking credentialing. The following credentials are verified, if applicable, as part of the credentialing or recredentialing process:
- Board Certification
- Education and Training
- Work History
- Hospital Affiliations and Privileges
- State Licensure or Certification
- State sanctions, restrictions on licensure or limitations on scope of practice
- DEA Registration
- Professional Liability Insurance Coverage
- Professional Liability Claims History
- CMS Sanctions – Medicare and Medicaid
- Disclosure of Ownership and Controlling Interest Statement
- Disclosures
The National Practitioner Data Bank (NPDB) is queried
You will be notified by telephone or in writing if any information obtained in support of the credentialing or recredentialing process varies substantially from the information you’ve submitted. Examples of discrepancies include actions on a license, malpractice claims history, suspension or termination of hospital/clinical privileges, or board certification status.
You have the right to review the information submitted in support of the credentialing process and to correct any errors in the documentation. We will not provide references, recommendations, peer-review protected information, or information of which disclosure is prohibited by law in response to the request.
To review or correct information you must submit a written explanation to the address below, or appear before our credentialing committee if deemed necessary. You will have thirty (30) calendar days to comment and correct erroneous information. No final credentialing determination will be made until you have responded or the thirty (30) day period has elapsed. We will document receipt of the corrected information in your credentialing file.
INTotal Health
Attn: Credentialing
3190 Fairview Park Drive, Suite 900
Falls Church, VA 22042
You also have the right to inquire about the status of your credentialing or recredentialing application. You may do so by the following methods: (1) telephone by contacting Provider Relations at 1.800.231.8076, (2) facsimile to 888.881.6166, (3) contacting your Provider Relations representative, or (4) in writing to the address below:
INTotal Health
Attn: Credentialing
3190 Fairview Park Drive, Suite 900
Falls Church, VA 22042
We will confirm the status of your application with our Credentialing Department, who tracks the credentialing process in a secure database, and will respond to your inquiry by telephone or in writing.