About this Provider Information

Plan and Specialty Help

The links below provide some more information on our products as well as definitions of the specialties referenced within the provider tool.

Plan Details

Glossary of Specialties

Provider Directory Disclaimer

Some of the information contained in the listings in this directory was obtained from the health care professionals themselves. However, Independent Health will use reasonable efforts to validate the accuracy of such information and to update the information on a daily basis except Sundays. Since information about a health care professional - including his or her participation in a network may change, we recommend that you verify with the professional his or her address and participation in the network. The data files may be downloaded and/or reprinted for personal use only. Permission to reprint or electronically reproduce any document or graphic in whole or in part for any reason except for personal use is expressly prohibited, unless prior written consent is obtained from the appropriate Independent Health copyright holder.

Independent Health gathers the following information from the physician application form at the time a physician applies for network participation. At credentialing, a number of factors are verified with the primary source and every three years at re-credentialing. In addition, Independent Health periodically surveys practitioners and receives changes directly from practitioners and revises the Provider Directory accordingly.

To receive a printed copy of Independent Health’s physician/provider directory, please contact us.

Item
Description
Source
Frequency of Validation
Limitations

Practitioner Name

Credentialing application and NYS License Registration certificate.

At initial credentialing

Gender

Credentialing application

Self-reported

Specialty

The medical specialty or sub-specialty area in which the practitioner provides care.

Credentialing application and practitioner data change forms and surveys.

Appropriate training is verified by Independent Health with the specialty boards established by the ABMS and AOA. If the practitioner is not board certified, training is verified by the institution where the training occurred or through the AMA physician master file.
This occurs at credentialing and re-credentialing and when a change in specialties is requested by the practitioner.

Hospital Affiliations

The hospital(s) where practitioner has admitting privileges.

Credentialing and re-credentialing application and practitioner data change notifications.

Self-reported and verified at initial credentialing and re-credentialing.

Dependent on notification from the practitioner.

Medical Group Affiliations

The medical group(s) the practitioner is employed by or otherwise associated with.

Credentialing application, practitioner data change notifications.

At initial credentialing, re-credentialing and at other times when we are notified a practitioner has changed medical group affiliations.

Dependent on notification from the practitioner.

Acceptance of New Patients

Applies to primary care physicians (PCP's) and specialists only. Indicates if the practitioner is accepting new patients in his/her practice.

Credentialing application, practitioner data change notifications and surveys.

Self-reported by the physician on the application form at credentialing and verified with the office quarterly.

Dependent on notification from the practitioner.

Languages Spoken by the Practitioner or Clinical Staff

The languages (besides English) the practitioner speaks with sufficient fluency to treat patients who speak only that language.

Credentialing and re-credentialing application and practitioner surveys.

Self-reported

Dependent on notification from the practitioner.

Office Locations

The location of all offices the practitioner works.

Credentialing and re-credentialing application, practitioner data change notifications and surveys.

At initial credentialing, re-credentialing and at other times when we are notified a practitioner has changed office locations.

Dependent on practitioner notification.

Phone Number

The phone number of the practitioner’s office(s).

Credentialing and re-credentialing application, practitioner data change notifications and surveys.

At initial credentialing, re-credentialing and at other times when we are notified a practitioner has changed their phone number.

Dependent on practitioner notification.

Hospital Name

Marketing name of the hospital

Contract upon initial association with Independent Health and verified with the state operating certificate. Changes after initial contracting are submitted by the hospital via written notification.

At initial contracting and at other times when we are notified a hospital’s name changes.

Dependent on notification from the hospital.

Address

Street address of the hospital.

Contract upon initial association with Independent Health. Changes after initial contracting are submitted by the hospital via written notification.

At initial contracting and at other times when we are notified a hospital’s address is changing.

Dependent on notification from hospital.

Hospital Quality Data

Information on Hospital Quality is available through several websites.

NYS Hospital Profile Web Site: This site provides information about hospitals in New York State, and the quality of care they provide.

U.S. Health and Human Services Hospital Compare: This tool provides information on how hospitals care for adult patients with certain conditions or procedures.

The Leapfrog Group Hospital Quality: Leapfrog gathers information on hospital quality and patient safety efforts.

Accreditation

Accreditation is a voluntary process through which a hospital is able to measure the quality of its services against nationally recognized standards.

Upon initial credentialing with Independent Health, credentialing staff requests information regarding the current status of the hospital’s accreditation. A copy of the most recent accreditation certificate is obtained from The Accreditation organization, or provided by the hospital.

At initial credentialing and every three years, thereafter, Independent Health confirms the hospital continues to be in good standing with the accrediting body.

Board Certification

Board Certification is awarded to a physician who has satisfied the requirements and standards of a nationally recognized specialty board.

Independent Health verifies Board Certification through CertiFACTS, an official ABMS agent or through the American Osteopathic Association if applicable at initial credentialing.

At initial credentialing, quarterly and every 3 years at recredentialing.

To receive the most recent information on physician disciplinary actions you can log onto the Office of Professional Medical conduct (OPMC) website at http://www.health.ny.gov/professionals/doctors/conduct or call toll-free at 1-800-663-6114.