What is Credentialing?
Credentialing is the collection and verification of an applicant’s professional qualifications. The assessment and verification of these qualifications helps to confirm that the practitioner meets certain criteria relating to professional competence. It also includes review of relevant training, licensure, certification, and/or registration to practice in a health care field, and academic background. The Select Health Network (Select) credentialing process evaluates the qualifications of practitioners who provide care for Select members. The credentialing process is completed before a practitioner is approved to participate in Select.
How long does the credentialing process take?
The average turnaround time for credentialing is 30 - 90 days. Therefore it’s very important to begin the credentialing process as soon as possible to ensure that your provider is approved prior to his or her start date. Additionally, please make sure that applications are completed in their entirety and that fees, contracts, and requests for additional information are responded to in a timely manner. Final approval occurs at our Board of Directors meeting, which typically meets once per month.
Are hospital privileges required to join Select?
Most providers require hospital privileges at a participating hospital to join Select. Primary care physicians may have full or affiliate hospital privileges at a participating Select hospital. Specialist physicians are required to maintain full privileges at a participating Select hospital. Urgent care providers, and any provider specialty that would not be consulted in the hospital will be permitted to join Select with affiliate privileges. Physician Assistants, Nurse Practitioners, Certified Nurse Specialists, Certified Nurse Anesthetists, Registered Nurse First Assistants, locum tenens, and Dermatopathologists are not required to have privileges at a participating hospital.
Will Select backdate an effective date?
No, Select does not backdate effective dates.
Does Select credential locum tenens?
Yes, Select requires that locum tenens providers are credentialed prior to providing services to our members.
How often does Select recredential providers?
Recredentialing is conducted every two years after initial credentialing to ensure professional qualifications remain valid and current. Our credentialing standards are more extensive than, and fully compliant with, the National Committee on Quality Assurance (NCQA) requirements.
How do I submit demographic changes to Select?
Please submit all demographic changes to Select as soon as possible to ensure claims are processed correctly and our online provider directory is accurate. Please complete and fax the Provider Change Notification Form that can be found on our website on the Providers tab to Provider Relations at 574-283-5950 or email it to firstname.lastname@example.org.
How do I notify Select of a provider termination?
Please notify Select of terminations in advance of the termination date, 90 days advance notice is required by contract. Please fax a termination letter along with a Provider Termination Notification form that can be found on our website under the Providers tab to Provider Relations at 574-283-5950 or email it to email@example.com. Please specify the reason for termination on the bottom of the form. Providers must meet specific criteria to be eligible for a refund of their Membership Fees. If this section of the form is not completed, a refund will not be issued.
Who do I contact to check the status of my credentialing application or ask questions?
Please contact Jocelyn Minix by phone at 574-283-5927 or email at firstname.lastname@example.org.