Credentialing

Independent Physician Network’s Credentials 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 health care practitioners who need to bill insurance companies and receive compensation for their health care services. The Credentials Committee is comprised of IPN member physicians who practice in various specialties. Currently, five IPN member physicians serve on the Credentials Committee, as well as the IPN Medical Director.

With IPN, there is neither a fee for credentialing or re-credentialing 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 Credentials Committee for recommendation to the IPN Board of Directors.

IPN’s Credentials Committee follows the standards set by the National Committee on Quality Assurance (NCQA) when reviewing provider files. The criteria reviewed by the IPN Credentials Committee includes:

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

The standards IPN follows to credential its member physicians and contracted providers exceed the NCQA standards as those requirements only include verification of current documents—State of Wisconsin License, Malpractice Insurance, and DEA License—at the time of credentialing/recredentialing. 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 twelve contracted health plans. For those health plans, member physicians and contracted providers do not have to submit credentialing information on their own, saving both time and money. IPN also submits updated member physician/contracted provider information monthly to these contracted plans.

Another way 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. These site visits benefit our member physicians and their staff by ensuring they meet all medical office standards, which, in turn, benefits their patients. During site visits, IPN’s Senior Provider Relations Representative also reviews IPN’s contracted health plans and the contact, authorization, referral, and claims information for each plan with the office staff.