Credentialing

Prevea Health Network (PHN) will credential practitioners who will be participating in the network. PHN will credential and re-credential the following health care professionals and facilities:

• Doctors of: Medicine (M.D.); Osteopathic Medicine (D.O.); Podiatric Medicine (D.P.M.); Chiropractic (D.C.); and Optometry (O.D.).

• Doctors of Dental Science (D.D.S.) who provide care under the medical benefit program.

• Behavioral Health Care practitioners including but not limited to: Psychiatrists, Physicians certified in Addiction Medicine, doctoral level Clinical Psychologists (PhD), Licensed Marriage and Family Therapists, Licensed Professional Counselors, Licensed Clinical Social Workers, Alcohol and Drug Counselors, and other Counselors.

• Advanced Practice Nurse Practitioners; Certified Nurse Midwives; Physician Assistants; and other allied health professionals (for Occupational/Physical/Speech Therapists, we credential the site)

• Prevea Health Network includes the following facilities: hospitals, home health agencies, skilled nursing facilities, nursing homes, freestanding surgical centers, and behavioral health facilities providing mental health or substance abuse services in an inpatient, residential, or ambulatory setting.

With the exception of:

• Practitioners who practice exclusively within the inpatient setting of credentialed facilities and who provide care for organization members only as a result of the members being directed to the hospital or another inpatient setting.

• Practitioners who practice exclusively within freestanding facilities and who provide care for organization members only as a result of members being directed to the facility.

• Covering practitioners (e.g., locum tenens).

If a participating facility is already credentialed, any new provider coming in to that facility must be approved by PHN's credentialing process prior to seeing Prevea Health Network participants. Those providers or organizations already credentialed will still be able to see PHN patients. However, additional credentialing policies or procedures reflecting new requirements will be sent for review and completion by participating providers.