Why is Credentialing Necessary?

Documentation for credentialing applications is very important to ensure that InteCare’s network has providers that are qualified, competent as well as ensuring the safety and security of clients. Credentialing provides a way to verify qualifications and helps us verify that the information providers submit is correct and accurate. Primary and secondary source verification is essential to keeping our network in line with state law and national accreditation standards.

InteCare, Inc. is accredited through URAC and also complies with NCQA standards; therefore our credentialing process closely mirrors the standards of these organizations. Primary source verification is one of the ways that we assure the network is secured. Primary source verification means that we contact a third party such as the Health Professions Bureau to verify licenses directly from the issuing source. Our credentialing process requires that we primary source verify the provider’s education by requesting a transcript from a university, license through the Indiana Professional Licensing Agency, criminal history search through the Indiana State Police, and Medicaid/Medicare sanctions through the Office of the Inspector General. Standards are even more strict for MDs and DOs. We are required to primary source verify their privileges at hospitals they serve, and board certification or residency and CEU’s within the past 36 months if the provider is not board certified.

Secondary Source means documentation that came from an indirect source such as allowing a provider to submit to us a copy of their insurance. Some of the other Secondary Source information we collect includes a copy of the provider’s government issued photo ID and copy of their curriculum vita or resume with 10 years of work history noted. Utilizing this type of verification allows us to be certain that providers applying to be active in the network are competent. It also allows us to be alerted to any discrepancies in their qualifications before they are serving clients. This helps to ensure the safety of our clients and keep the integrity of our network in tact. If you would like any further information about our credentialing process or have any questions please contact the Credentialing Manager, Julie Maxwell-Coker at jmaxwellcoker@intecare.org (317) 829- 5759 or the Credentiaing Specialist Carol Gorbett at cgorbett@intecare.org (317) 237-5776.