Data Source Document


The Health Plan updates directory information about practitioners (physicians) and providers (hospitals/facilities) when new information is presented by a practitioner/provider. The directory is updated daily. Information regarding hospital accreditation is updated upon expiration. Specific information about practitioner training, such as medical school, accreditations, board certification and licensure, are confirmed through The Health Plan's initial credentialing process which includes verification with the issuing body or the state that issued the license. Credentialing occurs when a provider joins The Health Plan network initially. Data validation occurs at least every 36 months thereafter

Accepting new patients


This information is self-reported by the practitioner and updated upon notification. It is not verified by The Health Plan. If the practitioner has a restriction, such as age limitation and/or not accepting new patients, or only accepting existing patients etc. it will be reflected in the directory. If the practitioner has no restrictions listed, that indicates the practitioner has no restrictions to his/her practice. This information is validated at least every 36 months thereafter.

Accreditation


This information is verified directly with the accrediting organization before it is displayed in this directory. Accreditation is validated at least every 36 months thereafter. Accreditation specifies whether a hospital has applied for and met particular criteria related to quality of care performance from the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), the DNV National Integrated Accreditation for Healthcare Organizations (NIAHO) or the Healthcare Facilities Accreditation Program (HFAP). To receive and maintain accreditation, organizations must have an extensive on-site review at least once every three years to evaluate performance in areas that effect a patient's care. Accreditation displays that an organization is dedicated to ongoing efforts to improve the quality of care provided to patients.

Board Certification


Board certification is updated upon notification by the practitioner and verified by The Health Plan directly through Board Certified Docs (an official American Board of Medical Specialties display agent) or the pertinent board prior to adding to the directory. This information is validated at least every 36 months and quarterly upon expiration. The American Board of Medical Specialties website can be found at https://www.abms.org/verify-certification/. If applicable, this information specifies the American Board of Medical Specialties board through which the practitioner has obtained certification and the expiration date of the certification.

Facility Name


This is self-reported information by the provider and updated upon notification. It is not verified by The Health Plan. This information is validated at least every 36 months thereafter.

Facility Location


This is self-reported information by the provider and updated upon notification. It is not verified by The Health Plan. This information displays the location(s) at which the provider delivers services. This information is validated at least every 36 months thereafter.

Gender


This information is self-reported by the practitioner and updated upon notification. It is not verified by The Health Plan. This information is validated at least every 36 months thereafter.

Hospital Affiliations


Admitting privileges at the practitioner primary admitting facility are verified with the facility by The Health Plan or its designee initially. If applicable, hospital affiliations specify medical facilities where the practitioner has obtained privileges. This is self-reported information by the practitioner and updated upon notification. This information is validated at least every 36 months thereafter.

Languages spoken by the practitioner or office staff


The languages displayed in a provider directory are self-reported by the practitioner and updated upon notification. This information is not verified by The Health Plan. The Health Plan requests practitioners to report if the practitioner or his or her clinical office staff speak any languages other than English. This information is validated at least every 36 months thereafter.

Practitioner Name


This information is self-reported by the practitioner and updated upon notification. It is not verified by The Health Plan. This information is validated at least every 36 months thereafter.

Medical Group Affiliations


This is self-reported information by the practitioner/provider and updated upon notification. It is not verified by The Health Plan. This includes the medical groups with whom the practitioner/provider has a professional relationship. This information is validated at least every 36 months thereafter.

Office Locations and Phone Numbers


This is self-reported information by the practitioner and updated upon notification. It is not verified by The Health Plan. This information displays the location(s) at which the practitioner delivers services and the phone numbers to contact the office. This information is validated at least every 36 months thereafter.

Specialty


The Health Plan or its designee verifies this information directly from the appropriate entity. This information is the practitioner’s self-reported field of specialty. A practitioner’s specialty listing in the directory is based on the verification of the practitioner's education, training (e.g. residency, fellowship), experience, and/or board certification/accreditation if applicable. This information is validated at least every 36 months thereafter.