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NCQA Certification Information
 
 
 
Providers

ConnectCare recognizes the vital role that you, as providers, perform in the success of the ConnectCare PPO. Connecting our health care providers to payors and consumers is paramount to a successful relationship. We share your commitment to providing the highest standards of medical care to our ConnectCare members.

ConnectCare uses a specific network of health care providers such as hospitals home health agencies, and skilled nursing facilities, evaluating their accreditation status, licensure and sanction information to ensure that they are in good standing with regulatory bodies and accreditation organizations.

We also assume the responsibility for selecting and evaluating practitioners via a fair, accurate and non-discriminatory method, recognizing that practitioners assume responsibility for managing the health care of our enrollees. If you are a practitioner who wishes to participate with the ConnectCare PPO network, you are expected to:

  • meet the requirements of the credentialing program
  • have admitting privileges or arrangements at a contracted network hospital
  • join the physician organization
  • meet the network or geographic access needs for members
  • cooperate with Utilization Management and Quality Improvement activities
  • direct patients to other network practitioners for specialty care and to network provider hospitals, facilities, and laboratories for testing and treatments whenever possible

ConnectCare Certified by NCQA in Utilization Management
Certified since 2007

NCQA “Achieving Utilization Management Certification from NCQA demonstrates that ConnectCare has the systems, process and personnel in place to conduct utilization management in accordance with the strictest quality standards.” – Margaret E. O’Kane, President, NCQA

NCQA has reviewed and certified ConnectCare’s Utilization Management functions. For complete details on the scope of this review, visit www.ncqa.org.

If you are interested in learning more about participation with ConnectCare, please contact us via e-mail at info@connectcare.com or by telephone at (888) 646-2429.


 

 
   
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