Physician Information Validation

Security Health Plan collects and verifies all provider credentials in accordance with NCQA standards for primary source verification. Board certification is verified using American Board of Medical Specialists (ABMS), American Osteopathic Association (AOA), American Board of Podiatric Orthopedics and Primary Podiatric Medicine (ABPOPPM), American Board of Oral and Maxillofacial Surgery (ABOMS), American Board of Podiatric Surgery (ABPS), or American Medical Association (AMA) physician master file.

Item	Description	Source	Frequency of Validation	Limitations
Physician Name		Credentialing and recredentialing application and provider update forms	At initial credentialing and recredentialing	We are not always notified of a name change prior to the physician's recredentialing
Gender		Credentialing and recredentialing application	Self-reported - not validated	Some physicians may not provide this information
Specialty	The specialty or sub-specialty area in which the physician provides care	Credentialing and recredentialing application and provider update forms	At initial credentialing, recredentialing, or when notified of a change in specialty
Hospital Affiliations	The hospital(s) where the physician has admitting privileges	Credentialing and recredentialing application	Self-reported - not all are validated	When physicians change service locations, hospital affiliations may not be updated
Medical Group Affiliations	The medical group(s) the physician is employed or associated with	Credentialing and recredentialing application and provider update forms	At initial credentialing and recredentialing and when notified that a physician has changed or terminated with a medical group	We are not always notified when a physician changes medical group affiliations
Acceptance of New Patients	Indicates if the physician is accepting new patients at the location(s) he/she provides care	Recredentialing application and provider update forms	Self-reported - not validated	We are not always notified of changes
Languages Spoken by the Physician or Clinical Staff	Languages fluently spoken by the physician in addition to English	Credentialing and recredentialing application	Self-reported - not validated	Not all physicians provide this information
Office Locations	The location of all offices where the physician works	Credentialing and recredentialing application and provider update forms	At initial credentialing and recredentialing, and when notified of location change	We are not always notified of changes

Hospital Information Validation

Security Health Plan verifies the name, location, and accreditation of each affiliated hospital no less than every three years.

Joint Commission (JCAHO) accreditation is recognized nationwide as a symbol of quality and safety that reflects an organization's commitment to meeting certain performance standards. Hospital Compare, provided by the United States Department of Health and Human Services (HHS), is information that will help you compare the quality of care provided by our affiliated hospitals. Security Health Plan strongly encourages affiliated hospitals to participate in organizations that focus on safety activities and reporting such as Checkpoint, Leapfrog and the Wisconsin Collaborative for Healthcare Quality, Inc. (WCHQ).

Item	Description	Source	Frequency of Validation
Hospital Name	Marketing name of the hospital	Initial contracting with Security Health Plan and update notification forms	At initial contracting and when notified of a hospital's name change
Address	Street address of the hospital	At initial contracting with Security Health Plan and practice update forms	At initial contracting and at other times when we are notified a hospital's address has changed
Accreditation	Accreditation is a voluntary process through which a hospital is able to measure the quality of its services against nationally recognized standards	Upon initial contracting with Security Health Plan, a copy of the hospital's accreditation certificate or letter of notification is requested. Contracting staff will verify that the hospital has met all state and federal licensing and regulatory requirements and has been approved by a recognized accrediting body.	Security Health Plan requires initial and ongoing assessment reviews (at least every three years) of hospitals with which it contracts for member services. The QA Committee reviews issues identified that raise a significant concern regarding the hospital's ability to render quality health services to members.