All available provider information is validated, at a minimum, every three years through credentialing process.
Information provided directly by provider.
- Provider or Group name – all or part of the doctor’s name or practice’s name
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- Facility Name – all or part of the hospital’s name.
- Gender – M=male; F=female.
- Medical group affiliations, if applicable – an organization that a group of doctors/practitioners are directed by.
- Languages – all languages spoken by provider/clinical staff are listed.
- Accepting new patients – if provider is currently accepting new patients (applies to general and internal medicine, family practice, pediatrics, obstetrics/gynecology and high volume behavioral health.
Information provided directly by provider but validated through industry standard sources.
- Specialty category – General category of specialty, eg., Pediatrics.
- Specialty – individual specialties within the general specialty category, eg., Pediatric Cardiology (specialty includes all that are applicable, subspecialty is optional).
- Network – your health benefit plan’s provider network.
- Zip Code – identifies the location of the provider practice.
- Board certification with expiration date – A physician’s advanced credentials indicating a high degree of competence and training in their area of specialty.
- Accreditation – voluntary process to be surveyed against industry standards for comparative purposes.
- Hospital Affiliations – admitting/attending privileges at listed hospitals.
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Real Time Icon - Providers who display a
icon have the capability to receive a claim estimate and also submit claims--in real time--before you leave the office. This allows providers to estimate your responsibility at the point of service, reducing confusion and administrative hassles.