There are several ways we obtain, update and validate the information contained in our provider directories to ensure it is timely and accurate.
Acceptance of Established Patients Only
This field indicates whether a practitioner is currently taking new patients. The medical group/provider notifies Prominence Health Plan when it learns a practitioner’s practice is “closed” to new patients. Prominence Health Plan periodically contacts medical groups/providers to validate this information. Please note there are times that a medical group/provider may not immediately know that a practitioner has limited his/her practice. Before you select a primary care provider (PCP) it is always best to contact that PCP’s office to verify they are accepting new patients.*
To be accredited, a hospital voluntarily submits to an ongoing evaluation process to determine if it meets the standards that have been established by a recognized accrediting body. Prominence Health Plan recognizes the accrediting bodies listed below. A hospital that is fully accredited by any of these organizations is in full compliance with rigorous national healthcare quality and safety standards. Obtaining such accreditation is validation of an organization’s ongoing performance improvement efforts. Hospitals are required to provide Prominence Health Plan with documents to support their accreditation when they are first credentialed and then, at a minimum, every three years after that as part of the re-credentialing process. You may verify a hospital’s accreditation status by visiting the following websites:
A specialist who has successfully completed a residency or fellowship program approved by the Accreditation Council for Graduate Medical Education (ACGME) in a specialty that is recognized by the American Board of Medical Specialties (ABMS) or by the American Osteopathic Association (AOA), and has been certified by an ABMS or AOA member board, is considered board certified. Board certification is verified by Prominence Health Plan when a practitioner is first credentialed, then every three years as part of the re-credentialing process or as the certification expires. You may verify a practitioner’s board certification by visiting the American Board of Medical Specialties. Patients who would like to check the certification of an osteopathic physician (DO) should also visit the American Osteopathic Association if the practitioner is not found on the ABMS website.
All board certifications listed are those issued by an ABMS or an AOA recognized board.
Language Spoken by Practitioner
Languages spoken by a practitioner are reported to Prominence Health Plan by the contracted medical group/practitioner at the time a provider is initially credentialed, then every three years as part of the re-credentialing process. If the provider has a language change, the Health Plan will update the provider directory. If you have a specific language need, contact the physician’s office directly to verify they can meet your needs.*
Medical Group Affiliation
This field designates the medical group, if any, with whom the physician is associated. When a physician joins or leaves one of Prominence Health Plan’s contracted medical groups, the contracted medical group must notify Prominence Health Plan. Medical Group information is updated upon initial credentialing and updated at least every three years upon re-credentialing.
Hospital Affiliation is where the physician or practitioner has clinical privileges. Prominence Health Plan validates this information through the hospital in which the physician or practitioner has indicated they have clinical privileges. This occurs at a minimum every three years or when the physician or hospital reports a change. Most physicians and practitioners, depending on their specialty, must maintain clinical privileges at a hospital that participates in Prominence Health Plan’s networks.
A specialty is a particular branch of medicine in which a practitioner focuses. A specialty may be based on a specific body system (such as the heart), a specific age group (such as pediatrics), or a complex scientific technique used to diagnose and treat certain types of disorders. A specialist may or may not be board certified but Prominence Health Plan requires and verifies appropriate (ACGME approved) training at the time a provider is first credentialed and whenever a change in specialty status is requested by the provider.*
Specialty is first captured upon initial credentialing, is verified through the provider education and state licensure verification process, and is updated at least every three years upon re-credentialing.
*Limitations to the accuracy of information in the Prominence Health Plan web-based or printed provider directory would be the result of human or computer error in requesting information, responding to a request, a data entry error, or in the timeliness of reporting. Prominence Health Plan printed directories are limited to the information available at the time the directory is printed.