Credentialing Criteria

For AmeriHealth Caritas VIP Care to evaluate a qualified health care provider the following criteria must be met, as applicable:

• A current unrestricted state license, not subject to probation, proctoring requirements,or any disciplinary action. A copy of the license must be submitted along with the application.
• A valid Drug Enforcement Agency (DEA) or controlled dangerous substances (CDS) certificate, if applicable.
• Education and training that supports the requested specialty or service.
• Foreign-trained providers: an Education Commission for Foreign Medical Graduates (ECFMG) certificate or number submitted with the application.
• Board certification for all providers who apply as a specialist. AmeriHealth Caritas VIP Care requires that all specialists be board certified or meet one of the following exceptions:
• Documented plan to take board exam.
• An associate within the group practice that the provider is joining is board-certified in the requested specialty.
• Demonstrated network need for AmeriHealth Caritas VIP Care.
• The following organizations are recognized by AmeriHealth Caritas VIP Care for purposes of verifying specialty board certification:
• American Board of Medical Specialties (ABMS).
• American Osteopathic Association (AOA).
• American Board of Podiatric Surgeons (ABPS).
• American Board of Podiatric Orthopedics and Primary Podiatric Medicine (ABPOP).
• Royal College of Physicians and Surgeons.
• Work history containing current employment, as well as explanation of any gaps within the last years.
• History of professional liability claims resulting in settlements or judgments paid by or on behalf of the provider.
• A current copy of the professional liability insurance face sheet (evidencing coverage).
• Providers who require hospital privileges as part of their practice must have a hospital affiliation with an institution participating with AmeriHealth Caritas VIP Care. Primary care providers (PCPs) must be able to admit as part of their hospital privileges. As an alternative, those providers who do not have hospital privileges, but require them, may enter into a collaboration agreement with a provider who can admit. Certified registered nurse practitioners and certified nurse midwives must have agreements with the covering physician.
• Adherence to the Principles of Ethics of the American Medical Association, The American Osteopathic Association, or other appropriate professional organization.