Prominence Health Plan considers many factors when choosing physicians and hospitals for our networks.

Quality of Care

Before providers join our networks, we check to see that they have the appropriate education, licensure and training to provide quality care.

We require that all providers meet our stringent credentialing standards, which include the verification of licensure, education, training and malpractice and sanction history prior to joining our network.

The ongoing quality monitoring of physicians and providers is accomplished by checking for licensure and sanctions, and investigating, tracking and monitoring member complaints about quality of care.

Member Experience

We listen carefully to our members’ feedback about physicians, providers and hospitals after they have joined our networks. We employ various survey methodologies and carefully review and investigate any member complaints.

Board-Certified Practitioner

A specialist who has successfully completed a residency or fellowship program approved by the Accreditation Council for Graduate Medical Education (ACGME) in a specialty that is recognized by the American Board of Medical Specialties (ABMS) or by the American Osteopathic Association (AOA), and has been certified by an ABMS or AOA member board, is considered board certified. Board certification is verified by Prominence Health Plan when a practitioner is first credentialed, then every three years as part of the re-credentialing process or as the certification expires. You may verify a practitioner’s board certification by visiting the American Board of Medical Specialties. Patients who would like to check the certification of an osteopathic physician (DO) should also visit the American Osteopathic Association if the practitioner is not found on the ABMS website.

All board certifications listed are those issued by an ABMS or an AOA recognized board.

Location

Easy and prompt access to the care you need is important. That’s why we work hard to include network providers in the areas we serve so you can get the care you need from local doctors, hospitals and other healthcare professionals.

To help ensure you can find the care you need, we consider the following:

  • How far you have to travel to see a provider
  • The number of available providers in your area
  • The number of primary care physicians in your area accepting new patients
  • The languages the providers speak
  • How long it takes to make an appointment and see a provider
  • How easily you can access routine, urgent and emergency care

Types of Providers

This field designates the medical group, if any, with whom the physician is associated. When a physician joins or leaves one of Prominence Health Plan’s contracted medical groups, the contracted medical group must notify Prominence Health Plan. Medical Group information is updated upon initial credentialing and updated at least every three years upon re-credentialing.

To best meet your healthcare needs, our networks include a wide range of healthcare providers. They include:

  • Primary care physicians
  • Specialists
  • Hospitals
  • Skilled nursing facilities
  • Behavioral health providers
  • Laboratories

How We Choose Providers

Prominence Health Plan considers many factors when choosing physicians and hospitals for our networks.

Quality of Care

Before providers join our networks, we check to see that they have the appropriate education, licensure and training to provide quality care.

We require that all providers meet our stringent credentialing standards, which include the verification of licensure, education, training and malpractice and sanction history prior to joining our network.

The ongoing quality monitoring of physicians and providers is accomplished by checking for licensure and sanctions, and investigating, tracking and monitoring member complaints about quality of care.

Member Experience

We listen carefully to our members’ feedback about physicians, providers and hospitals after they have joined our networks. We employ various survey methodologies and carefully review and investigate any member complaints.

Board-Certified Practitioner

A specialist who has successfully completed a residency or fellowship program approved by the Accreditation Council for Graduate Medical Education (ACGME) in a specialty that is recognized by the American Board of Medical Specialties (ABMS) or by the American Osteopathic Association (AOA), and has been certified by an ABMS or AOA member board, is considered board certified. Board certification is verified by Prominence Health Plan when a practitioner is first credentialed, then every three years as part of the re-credentialing process or as the certification expires. You may verify a practitioner’s board certification by visiting the American Board of Medical Specialties. Patients who would like to check the certification of an osteopathic physician (DO) should also visit the American Osteopathic Association if the practitioner is not found on the ABMS website.

All board certifications listed are those issued by an ABMS or an AOA recognized board.

Location

Easy and prompt access to the care you need is important. That’s why we work hard to include network providers in the areas we serve so you can get the care you need from local doctors, hospitals and other healthcare professionals.

To help ensure you can find the care you need, we consider the following:

  • How far you have to travel to see a provider
  • The number of available providers in your area
  • The number of primary care physicians in your area accepting new patients
  • The languages the providers speak
  • How long it takes to make an appointment and see a provider
  • How easily you can access routine, urgent and emergency care

Types of Providers

This field designates the medical group, if any, with whom the physician is associated. When a physician joins or leaves one of Prominence Health Plan’s contracted medical groups, the contracted medical group must notify Prominence Health Plan. Medical Group information is updated upon initial credentialing and updated at least every three years upon re-credentialing.

To best meet your healthcare needs, our networks include a wide range of healthcare providers. They include:

  • Primary care physicians
  • Specialists
  • Hospitals
  • Skilled nursing facilities
  • Behavioral health providers
  • Laboratories