During the credentialing process, a health plan verifies the accuracy of information on a prospective network provider's application. One true statement regarding this process is that the health plan
A) has a legal right to access a prospective provider's confidential medical records at any time
B) must limit any evaluations of a prospective provider's office to an assessment of quantitative factors, such as the number of double-booked appointments a physicianaccepts at the end of each day
C) is prohibited by law from conducting primary verification of such data as a prospective provider's scope of medical malpractice insurance coverage and federal tax identification number
D) must complete the credentialing process before a provider signs the network contract or must include in the signed document a provision that the final contract is contingent upon the completion of the credentialing process

Question

Quizplus · Accepted Answer

The best choice is D because it is true that a health plan must complete the credentialing process before a provider signs the network contract, or they must include a provision that the final contract is contingent upon the completion of the credentialing process. This is important to ensure that the provider is properly vetted and meets the qualifications and standards set by the health plan. A is false as health plans do not have the legal right to access a prospective provider's confidential medical records. B is false as the health plan may also assess qualitative factors such as quality of care and patient satisfaction during the credentialing process. C is false as by law health plans must verify a provider's scope of medical malpractice insurance coverage and federal tax identification number during the credentialing process.

During the Credentialing Process, a Health Plan Verifies the Accuracy