Credentialing Committee Decision Making Process (Non-Delegated)
Determination & Notice of Approval or Denial
After it completes the review and evaluation of all of the credentialing information, the National Credentialing Committee approves or denies participation.
For initial credentialing, we notify care providers of the National Credentialing Committee’s decision within 60 calendar days or as required by state law. For re-credentialing, we notify care providers if the National Credentialing Committee determines they are no longer eligible to participate in our network within 60 calendar days of the decision or as required by state law. We send written notice of re-credentialing approvals to care providers in Maryland, New York and Rhode Island.
Right to See Members
Approved does not mean “active.” Care providers may not begin seeing our members until both they and we have signed a contract and are in our systems, or they receive the effective date of their ‘Active’ status. We send written notice that the contract is active.