Pennsylvania Code
Title 28 - HEALTH AND SAFETY
Part I - General Health
Chapter 9 - MANAGED CARE ORGANIZATIONS
Subchapter L - CREDENTIALING
Section 9.762 - Credentialing standards
Universal Citation: 28 PA Code ยง 9.762
Current through Register Vol. 54, No. 12, March 23, 2024
(a) At a minimum, for PCPs and specialists, a plan shall verify the following credentialing elements:
(1) Current
licensure.
(2) Education and
training.
(3) Board certification
status.
(4) Drug enforcement
administration certification status.
(5) Current and adequate malpractice
coverage.
(6) Malpractice claims
history.
(7) Work
history.
(8) Hospital privileges if
the provider provides services at hospitals.
(9) Any other information the Department may
require.
(b) A plan shall verify, at a minimum, for non-PCPs and nonspecialists, current licensure and malpractice coverage, to the extent licensure and coverage is required by State or Federal law.
This section cited in 28 Pa. Code § 9.763 (relating to nonphysician providers at facility, agency or organizations).
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