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. Members can personally verify the board certification status of a physician at the web site of the American Board of Medical Specialties (ABMS) (http://www.abms.org), or American Osteopathic Association (AOA) (https://certification.osteopathic.org/).

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 provider 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
Board certification	Indicates what specialty the physician is trained in	Credentialing and recredentialing application and provider update forms	At initial credentialing and recredentialing and when certification expires per monthly reports	Physicians may not renew board certifications
Acceptance of new patience	Indicates if the physician is accepting new patients at the location(s) he/she provides care	Credentialing and 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

*Credentialing occurs when the provider and/or facility affiliates with the health plan. Subsequently, recredentialing occurs every three years.