Practitioner Rights During Credentialing Process - Washington State Local Health Insurance - CHPW
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Practitioner Rights During Credentialing Process

Right to Review Information to Support Application

Practitioners who have been or are in the process of being credentialed have the right to review credentialing information collected during credentialing, recredentialing and on-going review processes.

The practitioner has the option of contacting CHPW by email at [email protected], and if an appointment is required, the Credentialing Coordinator will schedule it at a mutually convenient time.

Practitioners may request a review of their credentials file by emailing the Credentialing Coordinator and scheduling an appointment with the Credentialing Staff. All reviews must be done in person at CHPW offices. A member of the Credentialing Staff will accompany the practitioner during the file review.

Items submitted by the practitioner, malpractice insurance information, licensing boards’ information, and the American Medical Association (AMA) or American Osteopathic Association (AOA) Masterfiles may be reviewed.

Peer review documents and references or other information that is peer review protected will not be shared with the practitioner. CHPW is not required to reveal the source of information that is not obtained to meet the primary source verification requirements or when law prohibits disclosure.

Right to Correct Erroneous Information

If information provided on the application varies substantially with information obtained through primary source verification, CHPW will notify the practitioner in writing within 10 business days of discovery.

The notification will include a summary or a copy of the submitted application or other document in question.  The practitioner will have 10 business days to provide a written response (via FAX, mail, or email) to CHPW explaining the discrepancy to the best of his or her ability.

The practitioner is required to provide the response to the Credentialing Specialist assigned to processing his/her application. Upon receipt, the Credentialing Specialist will evaluate the received information to ensure that it meets standards and add all documents to the practitioner’s file.

Right to be Informed of Application Status

Upon request, CHPW will provide the practitioner with the status of his or her application.  Practitioners may contact the Credentialing Specialist for this information.

Credentialing Staff may share other information with the practitioner regarding his or her file except for information that is peer protected.


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