Credentialing

Notice of Provider Rights

SummaCare offers all providers the right to:

  1. Be notified if any information obtained during the credentialing or recredentialing process that varies substantially from the information provided to SummaCare. For example, this would include a substantial variation in information on actions on licensure, malpractice claims history, board certification decisions, etc. This does not include references, recommendations or other information that is peer-review protected.

    The physician/practitioner will be notified by fax, email or certified mail—return receipt of any discrepancies and will be given the opportunity to correct or clarify the information. SummaCare is not required to reveal the source of information if the information is obtained to meet credentialing verification requirements or if disclosure is prohibited by law.

    The notification will include a statement that the provider has the right to correct erroneous information supplied by another party. Providers must respond in writing within 30 business days of receipt of the notification to the appropriate credentialing personnel. The response, when received, will be date stamped and signed/initialed by the receiving party. A copy of the notification and subsequent responses will be maintained within the confidential individual provider’s file and will be used in consideration of the provider’s initial or continued participation on the SummaCare network panel.

    In the event no response is received from the provider, the information will be forwarded to the SummaCare Credentialing and Peer Review Committee for their review and determination.
  2. Review information submitted to support their credentialing or recredentialing application. This evaluation includes information obtained from any outside source (malpractice insurance carriers, state licensing boards, etc.). This does not include references, recommendations or information that is peer-review protected.
  3. Be informed, upon request, of the status of their credentialing or recredentialing applications. To obtain the status of your application, please contact the Credentialing office via email at adkinsc@summacare.com.