We recognize that our health binds us together. What we all do has an effect on others around us. As a result, we are committed to providing better care to our members, providing greater value to our consumers, and assisting in the improvement of the health of our communities.
We want to assist you in gaining access to high-quality, cost-effective care that is supported by scientific research. That is something we all want.
Why Do We Credential?
Credentials are assessed in accordance with policy criteria to ensure the competency and conduct of health care professionals serving members in our network.
Who Do We Credential?
We accredit licensed health care practitioners with whom the company plans to enter into contracts and promote to our members. Our Program Summary offers a comprehensive list of provider categories that we accredit as well as those that we do not.
Why Stars Pro?
We believe that everyone deserves access to high-quality health care at a reasonable cost. That is why we provide plans, extensive benefits, and access to some of the state’s largest medical networks. And, as a non-profit, we are delighted to give back to the communities we serve.
- Easily attainable at any time
- You can access your health plan from your computer or mobile device at any time of day or night
- Accessible from any location
- You can securely access your information from practically any location
- Coverage of high quality
- First to cover
- Volunteering is something we enjoy doing since it allows us to give back to our communities
- Assistance with finances
- We can assist you in determining whether you are eligible for financial assistance
Credentialing Criteria
When reviewing an application for network participation and credentialing, we consider the following components as part of its criteria.
- Licensing
- A description of the current state of affairs
- Information about certification, training, and education
- Prescriptive Authority Sponsorship (if applicable)
- BNDD and CDS copies, as well as a curriculum vitae
How to Get Connected in Our Networks
We build provider networks through contracts with physicians and other professional providers, which are critical for providing excellent, accessible, and cost-effective health care services to our members.
If you want to join one of our provider networks, please follow the steps mentioned below. We are excited to collaborate with you!
Five Simple Steps to Join!
Step 1: Fill out the Provider Onboarding Form.
Step 2 — the Initial Review Procedure
A multidisciplinary team reviews requests to join the network. We work hard to keep health insurance inexpensive and available to everyone. As part of that commitment, we actively seek agreements that promote collaboration between our company and providers while also addressing network demands.
Step 3 — Get Credentials
All providers who join our networks must go through the certification procedure. Our credentialing procedures are in accordance with applicable law and accrediting standards. Will notify you of the outcome as well as any available appeal rights.
Step 4: Submit In A Signed Contract.
If you complete Steps 1-3 successfully, you may be offered a contract to participate in one or more networks. We will send you a welcome letter with your network’s effective date after we receive your signed contract(s) (s).
Step 5 – Get Connected.
We highly urge you to employ all available electronic solutions for electronic data interchange (EDI) transactions once you are a member of our networks to assist assure the timeliness, accuracy, and security of claims-related information. Please see our website’s Electronic Commerce section under “Claims and Eligibility.
Credentialing Process Requirements
We reviewed carefully each practitioner/provider with whom we work. Prior to the initial contracting, the practitioner/provider is checked to ensure the following:
- Current copy of valid state license
- If you do not have admitting privileges, you must use your current primary admitting hospital or create a written coverage plan (if applicable)
- A current copy of a legitimate Drug Enforcement Administration (DEA) certificate for the state in which they practise, if applicable.
- As relevant, board certification/education
- Work experience (within the last five years) must be in month/year format
- For the contractual location(s), a current copy of acceptable malpractice insurance face sheet is required (also known as Professional Liability or Certificate of Liability Insurance)
- Responses to professional inquiries (see application)
- Attestation and authorization from a physician or other practitioner
- To participate in our network, the practitioner/provider must first be credentialed by us and sign our Practitioner Agreement. A completed application does not guarantee participation. When confirming the information supplied in the application, we contact the issuing source or a recognized source as part of the credentialing process. This is referred to as “Primary Source Verification.” We do this by relying on well-known sources such as:
- Licensing-through a state licensing agency
- National Practitioner Information System (NPIS) (NPDB). We send a written notification on the contract status after the credentialing process is completed.
Re-credentialing process
To maintain quality standards, we re-credential established practitioners/providers every three years.
Contracting Process
After the provider signs the contract and we countersign it, the newly credentialed and contracted physician or other provider can offer medical services to our members and submit claims for payment. If the new physician or other provider is entering a contracted group practice, an individual contract may not be required; nevertheless, we still demand that all physicians and other providers be credentialed first.
Please Contact Us
Do you require assistance? If you have any additional general questions about being a CareSource provider, please contact Stars Pro Credentialing Specialist 1-732-523-4633.