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Recredentialing
At three-year intervals, we recredential providers and facilities to verify that criteria for participation continue to be met. To allow sufficient time for processing and committee review, we send renewal applications at least four months before the third anniversary of the contract date. If the contract anniversary date is missed before recredentialing is complete, participation is considered to have expired unless renewed by Midlands Choice.
In addition to updates of the documentation that was required for initial credentialing (license, education, certification, as applicable to the provider or facility type), renewal information presented to the credentialing committee will include any member complaints, network sanctions, and deficient scores from medical records or site surveys.
Incomplete applications are held open for 30 days to allow time for submission of any required information or documentation that is missing. If information is not received within 30 days, the application will be treated as having been withdrawn and the provider's participation will be terminated according to the terms of the Plan Provider Agreement.
Network physicians' medical records are reviewed two years after initial credentialing as part of our quality review process.
