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Practitioner credentialing rights

Practitioner and organizational provider credentialing rights

After the submission of the application, health care providers have the following rights:

  • To review information submitted to support their credentialing application, with the exception of references, recommendations, and peer-protected information obtained by the plan.
  • To correct erroneous information. When information obtained by the Credentialing department varies substantially from information provided by the provider, the Credentialing department will notify the provider to correct the discrepancy.
  • To be informed, upon request, of the status of their credentialing or recredentialing application.
  • To be notified within 60 calendar days of the Credentialing Committee/Medical Director review decision.
  • To appeal any credentialing/recredentialing denial within 30 calendar days of receiving written notification of the decision.
  • To know that all documentation and other information received for the purpose of credentialing and recredentialing is considered confidential and is stored in a secure location that is only accessed by authorized plan associates.
  • To receive notification of these rights.

To request any of the above, the provider should contact the Keystone First Credentialing department at the following address:

Keystone First
Attn: Credentialing Department
200 Stevens Drive
Philadelphia, PA 19113