Credentialing Criteria

1. Practitioner has a current unrestricted/unconditional license/registration in each state services are provided and certification as required.

2. Practitioner with hospital admitting or attending privileges, is a member in good standing of the medical staff of a PreferredOne participating hospital. Tex existence of any restrictions on privileges must be disclosed and will be examined and acted upon as deemed necessary by the Credentialing Committee.

3. Practitioner maintains professional liability (malpractice) insurance in amounts as established from time to time by the PreferredOne Board of Directors. The current requirement is $1 million per occurrence and $3 million in aggregate. Deviation may occur provided they are in accordance with applicable community standards in the state(s) of practice.

4. The presence of any past disciplinary or corrective action or current investigation by the State Licensing, Certifying or Registering Board or any other regulatory authority (i.e. Medicare, Medicaid, etc) having jurisdiction over the practitioner is disclosed and will be examined and acted upon as deemed necessary by the Credentialing Committee.

5. The existence of any pending or past professional liability claims is disclosed and will be examined and acted upon as deemed necessary by the Credentialing Committee.

6. Practitioner agrees to authorize review organizations to release to PreferredOne any information relating to practitioner’s professional competence or conduct. Practitioner may also present his/her own information.

8. At the time of (re)credentialing, Practitioner agrees to inform PreferredOne of any changes in licensure, disciplinary actions, professional liability actions, or practice circumstances.

9. At the time of (re)credentialing, Practitioner agrees to inform PreferredOne of pending charges or if currently charged with or ever been indicted or found guilty of a felony, gross misdemeanor, misdemeanor (other than a minor traffic violation), or other offense.

10. Practitioner has an absence of a physical or mental condition that would adversely affect the practitioner’s ability with or without accommodation, to provide appropriate care to patients.

11. Practitioner is able to perform the essential functions in the practitioner’s area of practice without posing a health or safety risk to patients.

Provider Credentialing Program Overview

Credentialed/Non-Credentialed Provider Types

Specific Criteria for Provider Types

Participating Provider Criteria for PreferredOne Health Delivery Organizations