Credentialing Services

Credentialing Services

Image: Learn more about the benefits of membership in the Independent Physicians Network.

Independent Physician Network (IPN) utilizes a proprietary system which exceeds National Committee for Quality Assurance (NCQA) standards for credentialing its member physicians. IPN, provides the service for credentialing and recredentialing to become an IPN member or contracted provider at no cost. 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.

IPN’s Credentialing Committee oversees the process of authenticating the qualifications of licensed medical professionals to assess their experience, education, and training for legitimacy. 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

Because NCQA standards and requirements only include verification of current documents—State of Wisconsin License, Malpractice Insurance, and DEA License—at the time of credentialing/recredentialing, the standards IPN follows to credential its member physicians and contracted providers exceed national recommendations. IPN member physicians and contracted providers are recredentialed every three years.

Currently, IPN provides credentialing services for its member physicians and contracted providers for each of IPN’s contracted health plans. Additionally, IPN submits updated member physician/contracted provider information monthly to these contracted plans.

IPN continues to exceed NCQA standards 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 benefit member physicians and their staff by ensuring they meet all medical office standards, which, in turn, benefits their patients.

Additionally, IPN’s Senior Provider Relations Representative provides education and training on IPN’s contracted health plans reviewing the details of our provider manual that includes the plan’s contacts, procedures for authorization, referral, and claims requirements for each plan with the office staff.

 

 

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