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Credentialing Rights


RIGHT TO NOTIFICATION AND CORRECTION OF INFORMATION


When DHP obtains credentialing information that is different than what the provider has provided, DHP will take the following actions:

    1. A phone call or a letter to the practitioner will be used to investigate and notify the practitioner of conflicting information.  If the practitioner has erred in his/her reporting, they will be required to resubmit information, within 30 days to a DHP Credentialing Specialist with the correct information, practitioner’s signature and date.  If the practitioner fails to comply, the issue will be taken to DHP Credentialing Committee for further discussion and recommendations.
    2. DHP will document request for information, date of request, who requested information, and the date that corrected information was received.
    3. If the practitioner maintains the information is correct, then the information in question will be reviewed and reverified.

DHP is not required to reveal the source of information if the information is not obtained to meet DHP’s credentialing verification requirements or if disclosure is prohibited by law.

Right to Notification and Correction of Information will be posted on the DHP website.

RIGHT TO VIEW INFORMATION

The provider has a right to review information obtained by DHP and to evaluate their credentialing application.  This evaluation includes information obtained from any outside source (e.g., Malpractice insurance carriers, and state-licensing boards).  This standard does not require DHP to allow a provider to review references or recommendations or other information that is peer review protected.  Providers must show identification and review information on DHP premises.

RIGHT TO REQUEST APPLICATION STATUS

The provider has the right upon request, to be informed of the status of their credentialing or recredentialing application.  The provider or the provider’s office staff may call the DHP Credentialing department for application status.