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Credentialing Criteria and Resources

Credentialing is required for all physicians who provide services to health plan members, as well as all other health professionals and facilities that are permitted to practice independently under state law and provide services to our members, with the exception of hospital-based health professionals.

Our credentialing process is designed to protect members and provide continued assurance that potential and/or currently participating providers meet the requirements necessary for the provision of quality care and service. The objectives of the credentialing program are to ensure that:

  • Members who join our health plans will have their care rendered by qualified providers.
  • Adequate information pertaining to education, training, relevant experience, and other credentialing criteria is reviewed by the appropriate individuals prior to approval or denial by the Credentialing Subcommittee.
  • Each provider applicant has equal opportunity to participate.

Note: If you are one of the types of providers listed below, you will need to join our network through one of our delegated vendors. Please check here for information about how to contact the appropriate delegated vendor directly.

  • Behavioral health specialist/OMH- or OASAS-certified facility/substance use provider
  • Dental provider 
  • Vision provider
  • Transportation provider
  • Pharmacy provider