Criteria for organizational providers
Organizations do not need credentialing for individual partners. Priority Health checks the OIG monthly to ensure that participating providers do not appear on the listing.
Demographic application only
The following organizational providers should use this application:
Organizational Provider - Demographic Application (106KB PDF).
- Ambulance
- Anesthesiology
- Audiology, hearing aid dealers
- Audiology, hearing aid screening
|
- DME
- Emergency medicine
- Independent diagnostic service
- Pathology
|
- Prosthecis/orthotics
- Radiology/imaging center
- School-based health clinic
|
Initial credentialing application
Providers other than those listed above should complete the Organizational Provider - Initial Credentialing Application (197KB PDF) and meet the requirements below.
| Requirements in addition to the application and addendum |
|---|
| Type of provider |
Michigan licensure (provider or facility) |
Liability
insurance
|
Accred./
certification:
Required
Preferred (not required) |
If no accreditation,
visit requirement* |
Not accredited
visit criteria
(website
verification) |
Free-standing surgical center
|
Yes, facility |
Yes |
Medicare & JCAHO or AAAHC or AAAASF
-- |
None |
None |
| Home health care |
No |
Yes |
Medicare
JCAHO/
CHAP
HFAP (AOA) |
CMS visit |
Greater than 5% avg. standard (high or low) |
| Home infusion |
No |
Yes |
Medicare
JCAHO |
None |
None |
| Hospitals |
Yes, facility |
Yes |
Medicare
JCAHO/
HFAP (AOA) |
CMS visit |
5 measures under Mich. standard |
Mental health facilities - Inpatient, residential, or outpatient setting (if not credentialed individually)
|
Yes
facility (IP)
provider (OP) |
Yes |
Medicare &
CARF or
JCAHO or
COA
-- |
None |
None |
| Skilled nursing facilities |
Yes, facility |
Yes |
Medicare
JCAHO |
CMS visit |
- Any level 4
- 3+ level 3
- 12% above/
below standard
|
| Sub/extended acute care |
Yes |
Yes |
Medicare
JCAHO |
CMS visit |
Ask for plan of action; site visit corrections |
Substance abuse - BH - Inpatient, residential, or outpatient setting
|
Yes |
Yes |
CARF or
JCAHO or
COA
-- |
None |
None |
| Urgent care centers (independent) |
Yes
individual |
Yes |
Medicare
JCAHO/
AAAHC |
PH visit |
None |
KEY:
JCAHO = Joint Commission on Accreditation of Healthcare Organizations
AAAHC = Accreditation Association for Ambulatory Health Care
AAAASF = American Association for Accreditation of Ambulatory Surgical Facilities
ABC = American Board for Certification
ACHC = Accreditation Commission for Health Care
AIM = American Imaging Management
AOA = American Osteopathic Association
CARF = Commission for the Accreditation of Rehabilitation Facilities
COA = Counsel on Accreditation
CHAP = The Community Health Accreditation Program
CAAS = Commission on Accreditation of Ambulance Services,
CMS = Centers for Medicare & Medicaid Services (formerly HCFA)
HFAP = Healthcare Facilities Accreditation Program (AOA)
*Priority Health reserves the right to complete an onsite visit.
