Providers: New Providers: Credentialing Process
Credentialing is a requirement for participation in the HBI network. Practitioners interested in applying for privileges need to submit an application to the HBI network.
- Upon receiving the application, and based on HBI's need for geographic access, you will be sent a notification/credentialing packet to be completed and submitted within 30 days.
- If the packet is not returned within 30 days, a reminder letter is sent to the practitioner.
- If there is no response from the practitioner within 14 days, the file is closed.
- Upon receiving a completed credentialing application, HBI will conduct primary source verification through the following agencies:
- state licensing board, requiring an unrestricted license
- malpractice insurance carrier, with history of liability claims
- Federal DEA (for Psychiatrists and Addictionologists)
- State Pharmacy Board (for Psychiatrists and Addictionologists)
- National Practitioner Data Bank
- Medicare and Medicaid Sanction Report
- In addition, HBI will verify:
- board certification (if applicable)
- clinical privileges (if applicable)
- work history
- specialized training and education
- professional references
- Prior to review and approval by the Credentials Committee, the following must be completed:
- Attendance at the HBI orientation meeting for providers in Southern Nevada, telephonically for providers outside of Southern Nevada. (2 CEU's will be offered upon completion of orientation.)
- All MD's/DO's must have a facility site review.
- After completion of the above, the application will be sent to the Credentialing Committee for approval or disapproval. Notification will be sent within 60 calendar days to the practitioner for either acceptance or declination of their credentialing application.
- Providers are notified about information obtained during the HBI credentialing process that varies substantially from the information provided in the credentialing application.
- The following items may be considered to exclude the practitioner from becoming a participating provider:
- NPDB - Any reported claims are submitted to the Credential Committee for review and recommendation.
- Multiple malpractice claims that indicate a propensity for malpractice and/or are unusual for a provider in the psychiatric specialty.
- Committee establishes that there is a conflict of interest with the provider and HBI that would be detrimental to provide services.
- As a provider you have the right to:
- Review credentialing information that is submitted to the Committee that is not protected by law.
- Correct erroneous information and resubmit for reconsideration.
- Be informed as to the status of your credentialing application.
Credentialing information provided to HBI is handled as confidential by the HBI staff and Credentialing Committee.
If you have any questions regarding credentialing, you may contact the HBI Credentialing Department.