Provider Manual Page 1 2 3 4 5
Credentialing
The credentialing process will verify the professional qualifications of all participating providers that provide services to our members. The initial credentialing process includes:
- Provider application to be completed in its entirety
- Copies of (and verification of)
- Licensure
- DEA registration
- Current, adequate professional liability insurance policy (face sheet from liability policy showing expiration dates and limits)
- Copy of Board certification certificate or specialty certificate for dentists (if not board certified, copies of residency certificates and medical school diploma)
- Hospital privileges (as applicable by Degree)
- Copy of W-9 for verification of each tax identification number used
Work History
- National Practitioner Data Bank Report
As documents from any of these areas expire, it is imperative that we receive updated information as quickly as possible.
Recredentialing
4MOST recredentials all practitioners in the network every three years. The recredentialing process includes verification of:
- Updated provider application
- Licensure
- Valid DEA certification
- Board certification status
- Current, adequate professional liability insurance policy (face sheet from liability policy showing expiration dates and limits)
- Professional liability claims history
- Current hospital privileges
- National Practitioner Data Bank Report
Standards for Participation
To become a 4MOST provider, 4 MOST must first assess the need in the requested geographic location, if the assessment shows a need, the provider will be sent a credentialing application and participation agreement. The provider must be credentialed and meet the standards of participation as developed by 4 MOST. A provider must maintain the following credentials, standards or processes:
- Drug Enforcement Administration (DEA) registration number (if the scope of practice warrants)
- Professional Liability Coverage – minimum amount of $1 million per occurrence, $3 million aggregate or an amount mutually agreed by 4MOST.
- Admitting privileges at a participating 4MOST hospital (as applicable to specialty)
- Board Certified or Board Eligible, if not Board certified or Board eligible, the physician must demonstrate appropriate training for specialty listed
- Proof of state license
- Sufficient information concerning any malpractice actions pending or resolved
- Completed confidential questionnaire
- Signed attestation document
- Signed and dated provider agreement
- Continued compliance with OSHA and CDC requirements
- Adhere to standard industry practice after hours coverage for patients, mechanism for handling emergency and urgent care treatment
- Agreement to accept reimbursement based on 4MOST fee schedule.
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