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Initial Credentialing

Prestige Health Choice is responsible for the credentialing of its provider network. The initial credentialing criteria and standards are consistent with Florida's state-specific requirements, Accreditation Association for Ambulatory Health Care (AAAHC) requirements and National Committee for Quality Assurance (NCQA) standards. Unless otherwise required, providers are re-credentialed at minimum every three years.

Hospital-based physicians are not required to be independently credentialed if those providers serve Prestige Health Choice members only through the hospital.

Prestige Health Choice maintains criteria and processes to credential the following practitioners:

  • Medical Doctors (MDs)
  • Doctors of Osteopathic Medicine (DOs)
  • Doctors of Podiatric Medicine (DPMs)
  • Doctors of Chiropractic Medicine (DCs)
  • Certified Registered Nurse Practitioner (CRNPs)
  • Advanced Registered Nurse Practitioner (ARNPs)
  • Physician Assistants (PAs)
  • Certified Nurse Midwives (CNMs)
  • Audiologists (AUDs)
  • Occupational Therapists (OTs)
  • Physical Therapists (PTs)
  • Speech and Language Therapists (SPTs)
  • Licensed Dietician Nutritionists (LDNs)
  • Others as agreed to by the Credentialing Committee

Prestige Health Choice maintains criteria and processes to credential the following provider types:

  • Hospitals (acute care and acute rehabilitation)
  • Home health agencies/Home health hospice
  • Skilled nursing facilities
  • Skilled nursing facilities providing sub-acute services
  • Assisting Living Facilities
  • Nursing Homes
  • Free-standing surgical centers
  • Ambulatory Surgery Centers
  • Sleep Center/Sleep Lab – Free Standing
  • Laboratory Centers
  • Infusion Agencies
  • Radiology Centers
  • Audiology, Speech, Occupational & Physical Therapy Centers
  • Orthotics and Prosthetics
  • Durable Medical Equipment Suppliers (DME)
  • Others as agreed to by the Credentialing Committee

Provider Re-credentialing

All credentialed providers must remain in compliance with initial credentialing criteria. The Plan will re-credential network providers at a minimum every three years. All Providers involved in the re-credentialing cycle are sent a Re-Credentialing Notification Letter approximately six months prior to the re-credentialing due date. The information requested in order to complete the re-credentialing process includes but is not limited to:

  • Application – Credentials Update Form or CAQH Universal Provider Data source – Provider CAQH reference number
  • Evidence of current Professional Liability Insurance
  • Credentialing Attestation & Release Form
  • Office Hours/Patient Load Form/Service Addresses
  • Supporting Documents – current State professional license, Federal DEA registration, State Controlled Substance Certificate, Malpractice Face Sheet, CLIA (if applicable)
  • In addition, at the time of re-credentialing, quality measures will be reviewed including member satisfaction, complaints, medical record review scores, peer review issues and other quality improvement issues.

Learn more about initial credentialing and re-credentialing criteria and standards in the Prestige Health Choice Provider Manual (PDF).