Provider Credentialing Program Overview
PreferredOne’s credentialing program is accredited by the National Committee for Quality Assurance (NCQA). Practitioners are required to submit the MN Uniform Credentialing application through the Minnesota Credentialing Collaborative (MCC) at www.mncred.org. The Minnesota Credentialing Collaborative (MCC), sponsored by the Minnesota Medical Association, Minnesota Hospital Association and the Minnesota Council of Health Plans, has developed a centralized, web-based clearinghouse for information used in the credentialing process. The data submitted to PreferredOne requires PreferredOne’s timely verification of information to ensure that practitioners have the legal authority and relevant training and experience to provide quality care.
NCQA also requires that practitioners be re-credentialed every three years. Notification to the practitioners is sent approximately four to six weeks prior to the practitioner’s due date. Practitioners must update the Minnesota Credentialing Application at www.mncred.org and submit the updates and supporting documents in the timeframe specified by PreferredOne to avoid participation termination. PreferredOne incorporates performance data such as utilization review and quality information and identifies changes that have occurred since the last credentialing which may affect the care provided to members.
In addition to compliance with the PreferredOne Credentialing program, practitioners must also comply with the PreferredOne Participating Practitioner Criteria identified in section B. Practitioners will not be denied participating status on the basis of sex, race, creed, color, national origin, age, disability, or sexual orientation. In order to support nondiscrimination, all Credentialing Committee members sign an affirmative statement to make decisions is a nondiscriminatory manner.
During the credentialing process, practitioners have the right to at anytime inquire about their credentialing status. The practitioner may contact PreferredOne Provider Relations department, who will then contact the Credentialing Department to obtain the exact status. This information will be reported back to the practitioner.
In the event that the information attested to on the application is inconsistent with the information collected in the credentialing process and where such inconsistency would result in the disapproval of an otherwise acceptable application, a letter will be sent to the healthcare practitioner notifying them of the inconsistency. The practitioner will have the right to correct any erroneous information. The letter will ask that the practitioner provide any pertinent information that will resolve the inconsistency. If the inconsistency is resolved, the credentialing process will continue. If the requested information is not received within 30 days from the date of the initial letter, a PreferredOne credentialing staff member will send another letter to healthcare practitioner/applicant informing them that the application process may cease and the provisional status of the practitioner may be terminated if the requested information is not received within an additional 30 days. If the inconsistencies cannot be resolved within these 30 days, the application process will cease and the application will be denied.
The PreferredOne Credentialing program may be delegated to contracted hospitals, Group Medical Practices or Physician Hospital Organizations (PHOs), if the delegate's policies and procedures comply with PreferredOne's policies. Interested providers may request a review by contacting the Network Management Department. The determination of readiness will include a review of the candidate's policies and procedures, an on-site visit, a review of provider files to assess completeness and compliance with standards and a review of the Credentialing Committee minutes. Assignment of the Credentialing Program to the Delegated Provider does not waive the requirements for continued compliance with the PreferredOne Participating Provider Criteria.