PROVIDER CREDENTIALING

HealthSmart understands that our networks are only as good as each of our individual providers. Each provider in a HealthSmart PPO network is fully credentialed based on URAC (Utilization Review Accreditation Certification) guidelines and must successfully complete our re-credentialing process every three years. To ensure the integrity of our networks, we only recruit potential providers who adhere to the following:

  • State licensing without restrictions or probation
  • Standards of service
  • Cooperation with review programs established by participating health plans
  • Acceptance of our contractual terms
  • Maintenance of malpractice insurance
  • Hospital privileges (physicians/practitioners)
  • Board certification (physicians/practitioners)
  • Malpractice history
  • Quality assurance issues
  • Hospital JCAHO
  • Universal Credentialing DataSource

 
 

We are pleased to participate in the Universal Credentialing DataSource, a project of the Council for Affordable Quality Healthcare (CAQH). This web-based solution allows you to store and manage your credentialing information online and share it with insurance carriers electronically. By using this single source, you'll no longer need to complete different credentialing applications for different insurance carriers. Just enter your information once and authorize insurance carriers (including HealthSmart) to access it. For more on CAQH, click here.