Credentialing

Credentialing

 

Independent Physician Network (IPN) utilizes a proprietary system which exceeds National Committee for Quality Assurance (NCQA) standards for credentialing its member physicians. With IPN, there is neither a fee for credentialing or recredentialing services nor a fee to become an IPN member or contracted provider. Applications to become an IPN member physician, contracted provider, or to be recredentialed through IPN are presented to and reviewed by the Credentialing Committee for recommendation to the IPN Board of Directors.

Credentialing Committee

IPN’s Credentialing Committee oversees the process of authenticating the qualifications of licensed medical professionals to assess their experience, education, and training. Credentialing is important for physicians and other healthcare practitioners who need to bill insurance companies and receive compensation for their healthcare services. The Committee follows NCQA standards when reviewing provider files, and the criteria reviewed includes:

  • Education
  • Board Certification
  • Work History
  • State of Wisconsin License, current
  • Current Malpractice Insurance, current
  • Current DEA License, current
  • Clinical Privileges
  • Sanction History
  • Claims History

IPN Exceeds National Standards

IPN’s credentialing program exceeds NCQA standards in order to insure that a quality network is in place for each of its contracted payers on a continuous basis.  This means that IPN continuously validates each member physician or contracted provider’s State of Wisconsin License, Malpractice Insurance coverage, and DEA License annually as each is renewed, not just at the three year intervals required by NCQA.  Additionally, IPN exceeds NCQA standards is by conducting required physician office site visits to all new physicians’ offices, including those offices opened by a provider after becoming an IPN member physician. Site visits also benefit member physicians and their staff by ensuring they meet all medical office standards, which, in turn, benefits their patients.

Currently, IPN provides credentialing services for its member physicians and contracted providers for each of IPN’s contracted health plans. This means that member physicians and contracted providers do not have to submit credentialing information on their own for IPN’s contracted health plans, saving both time and money. Additionally, IPN submits updated member physician/contracted provider information monthly to each of its contracted plans.

COVID-19 Resources: For all COVID-19 related resources, please click here.