Credentialing

Credentialing

MTI uses credentialing processes to provide our clients a selection of health care professionals who demonstrate backgrounds consistent with delivering high quality, cost-effective health care. We established criteria used to evaluate a provider’s credentials as a foundation for determining a provider’s eligibility and continued appropriateness for MTI’s network.

MTI requires all network providers to submit a written credentialing application prior to rendering services to or on behalf of MTI. The credentialing committee will request and verify items such as the applicant’s work history, current professional liability insurance, education, board certification (if applicable), history of loss, sanctions or other disciplinary activity. The process also consists of an on-site visit to assess the applicant’s location of practice or facility. MTI maintains the confidentiality of vendor’s information with limited access for each provider through the credentialing process. Providers are expected to remain in compliance with credential criteria at all times.

Credentialing Requirements

Provider Type, Agency/Organization Legal & DBA Names
  • Tax ID# (TIN), Physical & Billing Address
  • Current Federal, State, Local Licensures
  • Current Professional/Liability Face Sheets for each policy
  • Current Accreditations
  • Covered Services with description of services
  • Service Areas (GSA) by counties
  • Hours of Operations & after hours (on call) Protocol
Licensure & Certifications
  • State License/Registration #
  • Business/Vendor License #
  • Medicare Provider #
  • NPI Number/DEA # (if any)
  • Pharmacy Permit/License #
  • Bedding/Upholstery License (DME Provider only)
Accreditations-If Applicable
  • Accrediting Body
  • Accrediting Status
  • Expiration Date & Date of most recent survey
Liability and Professional Membership
  • Cancellation & non-renewed or restrictions by insurance carrier
Disciplinary Actions
  • Fines
  • Sanctions
  • Suspensions
  • Revoked, reductions or denials
Home Health Providers only
  • Copy of HCFA/CMS State Licensure & Revisits
  • Copy of Corrective Action Plan
  • Copy of Current QI/UM Program with appropriate signature pages, QI/UM policies & procedures, Annual reports and patient satisfaction surveys.
Diagnostic Imaging Providers only
  • Verification to meet NCQA Standards is performed
  • ACR Accreditation
  • JCAHO Accreditation Certificates
  • Department of Health Bureau of Radiation Control Certificate (for x-rays)
  • Reading Radiologist Requirements
    • State Medical License
    • Professional Liability Insurance Declaration pages
    • DEA Certificate/ CDS Status
    • Board Certification Status
Transportation Providers only
  • Full Criminal and OFAC background checks at inception and every 6 months thereafter
  • Department of Motor Vehicle background checks at inception and every 6 months thereafter
  • Vehicle Registrations
  • CPR/ EMS credentials verified at inception and yearly thereafter
  • State Certifications and licensing validation at inception and yearly thereafter
  • Drug screening attestation
  • Applicable Licenses and Certifications
  • Interpreter State / National Certification
Language Providers only
  • Full Criminal and OFAC background checks at inception and every 6 months thereafter
  • Drug screening attestation
  • Interpreter State / National Certification
  • Proficiency in both languages
  • Knowledge and intimate familiarity with both cultures
  • Industry knowledge and terminology of the subject to be interpreted
Physical Medicine Providers Only
  • Accreditation certificates such as CARF, JCAHO, NCQA.
  • Current facility business and/or Occupational license
  • General liability Insurance Declaration pages
  • Current state license and/or Clinic registration
  • Current W9
  • Therapist Requirements
    • Curriculum vitae
    • Current state license
    • Professional liability Insurance
    • DEA certificate/ CDS status
    • Board certification status