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Practitioner credentialing rights

Your rights:

  • The right to review your credentialing/re-credentialing information with the exception of references, recommendations, and peer-protected information obtained by Keystone First. If the credentialing department identifies a discrepancy on a provider’s credentialing/ re-credentialing application, they will contact you, either telephonically or by mail, to correct and/or supplement the information submitted on your credentialing/re-credentialing application.
  • The right to appeal any credentialing/re-credentialing denial within 30 days of receiving written notification of the decision.
  • All documentation and other information received for the purpose of credentialing and re-credentialing is considered confidential and is stored in a secure location that is only accessed by authorized plan associates.