Practitioner Rights Pertaining to Credentialing

Credentialing of practitioners is performed by the WPS Credentialing Department upon initial contracting of practitioners and every three years thereafter. Practitioners undergoing the credentialing process have the following rights:

• You have the right to review a summary of outside information obtained by the Credentialing Department for the purpose of evaluating your application.
• Requests to review a file shall be made to the Credentialing Manager.
• Providers shall not have access to references from other practitioners/healthcare facilities, recommendations or peer-review protected information received as part of the credentialing process.
• Providers may receive a copy of only those documents provided by, or addressed personally to, the provider. A written summary of all other information shall be provided to the practitioner by the Medical Director or his/her designee.
• You will be promptly notified of information that varies significantly from the information you have provided and be given the opportunity to submit updated/additional documentation or corrections to the Credentialing Department. The correction of erroneous information must be done, in writing, within ten (10) days of being notified of the varying information. The Credentialing Department is not obligated to reveal the source of information if disclosure is prohibited by law.
• You have the right, upon request, to be informed of the status of your application at any time. Requests shall be directed to Provider Credentialing@wpsic.com. The Credentialing Department shall promptly provide applicant with information regarding date of application receipt, general category of items outstanding and target approval date.
• You will be notified of the Credentials Committee decision regarding your application via written letter within 60 calendar days of the committee's credentialing or re-credentialing decision