FAQ Directory: Utilization Management, Credentialing and Provider Network

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8.24.2018 What organizations are eligible for Provider Network Accreditation?

To be eligible for Provider Network Accreditation, an organization must:

  • Not be licensed as an HMO, POS, PPO or EPO.
  • Not be eligible for NCQA Accreditation as a health plan or an MBHO.
  • Perform Provider Network functions directly or through contractual agreement.
  • Perform Provider Network activities for at least 50% of the provider network.
 

Note: A “practitioner network” is the practitioner network of clients and organizations.

UM_CR 2019