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Recredentialing Procedures

Midlands Choice recredentials network providers at three-year intervals as required by national credentialing organizations, such as NCQA and URAC.

To avoid disruption of in-network participation status, we mail recredentialing applications to practitioners four months before the end of the recredentialing deadline. 

During recredentialing, we verify credentials that may change over time, such as board certifications, medical licensure, and professional liability claim history since the last credentialing.  We also review any complaints or noncompliance with office site/medical records quality criteria and whether the provider has had any sanctions, license restrictions or limitations on the scope of practice.

Once the credentialing committee has reviewed the recredentialing application, we will notify the provider of the committee's decision within 10 business days.