Credentialing is a requirement for participation in the network and all providers must be credentialed prior to contracting. Recredentialing is conducted every three years in compliance with the National Committee for Quality Assurance (NCQA) credentialing standards.

Behavioral Healthcare Options has established credentialing standards for the following physicians and other licensed independent practitioners: MD, DO, A.P.N., P.A., Ph.D., Psy.D., Ed.D., LCSW, MSW, LMFT, MFT, MA, MS, M.Ed., LPC, CSW.

Credentialing will follow these four steps:

1. Completion of the credentialing application and submission by the provider of evidence of malpractice insurance, DEA and state pharmacy certificates.

2. Primary verification of the provider's credentials and query of appropriate monitoring agencies by SHS credentialing operations.

     Verification of information from primary sources:

• License: confirmation from appropriate state agency of license validity, expiration and information as to past, present or pending investigations or sanctions
• Clinical privileges: confirmation from hospitals of clinical privileges in good standing including date of appointment and any restrictions on the scope of privileges
• Education: Graduation from medical school and completion of a residency or board certification (if applicable)
• Malpractice: History of professional liability claims which result in settlements or judgments paid by or on behalf of the provider
• Professional references

      Queries performed:

• National Practitioner Data Bank
• Medicare and Medicaid Sanction Report

3. Review and approval or disapproval by the Credentialing Committee.

4. Notification to the provider of the Credentialing Committee's decision.

At the time of recredentialing, we also consider quality indicators such as data from member complaints, results of quality reviews, utilization management and patient satisfaction surveys. As an active partner in the credentialing process, you have the following rights: 1. The right to review information submitted to support your credentialing application that is not protected by law; 2. The right to correct erroneous information submitted by another party for use in the credentialing process; and 3. The right to be informed of the status of your credentialing or recredentialing application upon request. If you have any questions or concerns regarding your rights or your credentialing application, you may contact the Credentialing Department by phone at (702) 242-7559 or via fax at (702) 242-6781.

• Credentialing Application
• ReCredentialing Application