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Provider credentialing rights

Right to review information submitted

With the exception of peer references and National Practitioner Data Bank (NPDB) reports, providers have the right to review information that has been submitted to support the credentialing application. The provider also has the right to be notified if information received from the credentials verification organization (CVO) is substantially different than was reported by the provider. The provider will be notified of this right in the credentialing decision notification letter.

Right to correct erroneous information

The provider has the right to correct erroneous information submitted by another party. Corrections must be submitted in writing to the credentialing staff identified in the credentialing decision notification letter within ten (10) business days of receipt of the letter. Corrections or information received will be reviewed and documented in the provider's file. The provider will be notified of this right in the credentialing decision notification letter as described above.

Right to be informed of application status

A provider may request information about the status of his or her application at any time upon request. Such requests shall be made by calling the credentialing technician at 1-888-722-8646. The credentialing technician is free to provide all information about the status of processing the application; for example, acknowledging its receipt, advising that it has been sent to the CVO for primary source verification, advising that the application is scheduled to for presentation to the credentialing committee, etc.