I. Meet all credentialing and re-credentialing criteria.
II. Be a member in good standing of the Hurley Medical Center staff.
III. Hold a valid Michigan license of M.D., D.O., D.D.S., or D.P.M.
IV. Complete a (PMC generated) Michigan Association of Health Plans (M.A.H.P.) application.
V. Provide current copies of:
a. State of Michigan Board of Medicine Professional License
b. State of Michigan Board of Pharmacy Controlled Substance License
c. Federal Controlled Substance Registration Certificate (DEA)
d. ECFMG Certificate (if applicable)
e. Board Certification Documents
f. Professional Liability Insurance Certificate/Declaration Fact Sheet
g. Medical School/Internship/Residency/Fellowship Certificates
h. Curriculum Vitae w/work history showing month & year
i. CLIA Certificate (if applicable)
j. W-9 & IRS Tax Coupon or letter
VI. Document work history from end of training to present, month and year, explaining all gaps greater than 30 days.
VII. Provide malpractice claims history since completion of training and history of any cancellation of professional liability insurance.
VIII. Provide requested documents and complete initial application materials as requested; and each three years confirm the information on file, attest to fitness to practice, and supply all requested information about the previous three years.
IX. Notify Credentialing staff if you have been asked to complete any credentialing materials for a payer; asking for assistance in the completion and mailing of the materials.
X. Notify the Credentialing staff of changes to practice information
HPMS Obligations (HPMS Provider Services and Contracting Coordinator)
I. Set and monitor credentialing and recredentialing criteria.
II. Set up a hard copy and data file for each applicant.
III. Draw a timeline to follow educational and work history, documenting applicant’s statements regarding time lapses.
PMC Obligations (MAG Credentialing Manager)
IV. Verify staff appointment status at Hurley Medical Center and other listed facilities.
V. Verify graduation/successful completion of all educational programs, including medical school, internship(s), residency(s), and fellowships.
VI. Verify:
a. Medical School, Internship & Residency completion.
b. ECFMG Certification (if applicable)
c. Board Certification
d. Status of licensure and controlled substance certification
e. Professional Liability Coverage and claims history
f. Work History
g. Sanction/Criminal History
VII. Assure MAHP application completeness, cross check information provided on the application with verification information obtained.
VIII. Initially process each provider’s data and present to the Medical Management/Credentialing Committee for review and action. Each three years re-credential each provider according to NCQA standards.
IX. Submit appropriate provider credentialing documents to contracted health plans for the purpose of provider participation with health plan.
X. Maintain a current file of all credentialing documents for each provider; provide assistance with additional payer applications and supplying requested documentation at the request of the credentialed provider.
XI. Notify PMC/PO Contracted Plans of provider changes to practice information
Click here to apply and begin the initial credentialing process
