About Our Provider Network

Providers must meet credentialing criteria to become a network provider. These criteria include:

  • Signed application and agreement to participate  
  • Verification of unrestricted state medical license with appropriate licensing agency  
  • Verification of clinical privileges in good standing on the medical staff at a participating hospital               
  • Board certification status with the American Board of Medical Specialties or the American Osteopathic Association
  • Verification of education and training
  • Review of work history
  • Verification of prior sanctioning activities by regulatory bodies
  • Review of malpractice claims history
  • Verification of adequate malpractice insurance
  • Facility operating certificate
  • Medicare certification
The provider network includes a broad selection of provider types including but not limited to primary care, specialists, women's health, behavioral health, vision, dental, hospitals, durable medical equipment suppliers and pharmacies.
 
HealthNow, New York Inc. is committed to maintaining an adequate network of primary care, behavioral health, specialty care practitioners, and facility providers to ensure access to care within a reasonable distance in urban, suburban, and rural areas.

Our organization does not use quality measures, member experience measures, cost- related measures, or patient safety measures as selection criteria for allowing providers into the network.
 
Item Description Source Frequency of Validation Limitations (If Any)
Practitioner Name   Practitioner Every 3 Years. Upon notification from Practitioner when changing a name. None
Gender   Practitioner

Every 3 Years. Upon notification from Practitioner when updating information.

None
Specialty The type of care or conditions a practitioner specializes in, such as family  Practitioner Every 3 years. Upon notification from Practitioner when adding or changing a specialty. None
Medical Group Affiliations

The organizations, companies or medical groups the practitioner is employed by or associated with. An organization or group may have more than one care site.

Practitioner Every 3 years. Upon notification from Practitioner when adding or changing a medical group affiliation. None
Hospital Affiliations The hospitals where a practitioner is allowed to admit and care for patients. Practitioner Every 3 years. Upon notification from Practitioner when adding or changing a hospital affiliation. None
Hospital Name and Location       None
Hospital Accreditation An independent accreditation organization has recognized a hospital as meeting predetermined standards for quality of care and service. Two examples are the Joint Commission on Accreditation of Healthcare Organizations (Joint Commission) and National Integrated Accreditation for Healthcare Organizations (NIAHO). Provider Every 3 years. Upon notification from Provider when recertifying, adding or changing an accreditation. None
Board Certification Board certification involves rigorous testing by a recognized board of the American Board of Medical Specialties and is not required by most states. To verify a provider's board certification and status, visit the American Board of Medical Specialties Practitioner Every 3 years. Upon notification from Provider when renewing, adding or changing a board certification. Quarterly review of expired boards. None
Accepting New Patients? Indicates whether a primary care practitioner or personal physician is accepting new patients. A practitioner may have a full patient roster and cannot accept any new patients at this time.  Practitioner Every 3 years. Upon notification from Provider when adding or changing practice language information. None
Languages Spoken Languages, in addition to English, spoken by the practitioner and/or staff. Practitioner Every 3 years. Upon notification from Provider when adding or changing practice language information. None