About Our Provider Directory Information

This describes how we verify and update information about the doctors and other health care providers in our Provider Directory. This information complies with National Committee for Quality Assurance (NCQA) standards for health plan provider directories.

Item	Description	Source	Frequency of Validation	Limitations
Practitioner Name		Credentialing application	Every two years
Gender		Credentialing application	Self-reported, not validated	Not all practitioners provide this information
Specialty	The type of care or conditions a practitioner specializes in, such as family medicine, pediatrics, cardiology, or dermatology	American Board of Medical Specialties, the American Osteopathic Association and/or the American Medical Association	At credentialing and every two years during recredentialing or as soon as changes are reported
Medical Group Affiliations	The organizations, companies or medical groups the practitioner is employed by or associated with. An organization or group may have more than one care site.	Credentialing application	At credentialing and every two years during recredentialing or as soon as changes are reported	Not all practitioners provide this information
Hospital Affiliations	The hospitals where a practitioner is allowed to admit and care for patients	Credentialing application	At credentialing and every two years during recredentialing or as soon as changes are reported	Not all practitioners provide this information
Hospital Name and Location		Credentialing application	At credentialing and every two years during recredentialing or as soon as changes are reported
Hospital Accreditation	An independent accreditation organization has recognized a hospital as meeting predetermined standards for quality of care and service. Two examples are the Joint Commission on Accreditation of Healthcare Organizations (Joint Commission) and National Integrated Accreditation for Healthcare Organizations (NIAHO).	Credentialing application, verified by Group Health credentialing staff	At credentialing and every two years during recredentialing or as soon as changes are reported
Board Certification	Board certification involves rigorous testing by a recognized board of the American Board of Medical Specialties and is not required by most states. To verify a provider's board certification and status, visit the American Board of Medical Specialties	The American Board of Medical Specialties, American Osteopathic Association and/or American Medical Association	At credentialing and every two years during recredentialing or as soon as changes are reported
Accepting New Patients?	Indicates whether a primary care practitioner or personal physician is accepting new patients. A practitioner may have a full patient roster and cannot accept any new patients at this time.	Provider's office	As soon as changes are reported	Available for primary care (personal) physicians only
Networks	Lists of providers whom members can receive health care services from using their health plan benefits	Defined by Group Health	Annually
Languages Spoken	Languages, in addition to English, spoken by the practitioner and/or staff	Credentialing application	Self-reported, not validated	Practitioners and/or staff may speak languages they have not reported to us
Care Site	The location the practitioner most often provides care at. For Group Health providers this is a medical clinic or Central Hospital. For contracted providers, this is their main office location.	Credentialing application	At credentialing and every two years during recredentialing or as soon as changes are reported	Some practitioners may practice at more than one location