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

Providers