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.

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Demographic application only

The following organizational providers should use this application: Organizational Provider - Demographic Application (106KB PDF).

Ambulance	Hospice	Rehab-OT
Audiology - Hearing aid dealers	Independent diagnostic service	Rehab - PT
Audiology - Hearing aid screening	Laboratories	Rehab - ST
Dialysis	Prosthetics/orthotics
DME	Radiology/imaging center

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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	License under provider or facility	Liability insurance	Required accred./ certification	Preferred accred./ certification (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	N/A	Yes	Medicare	JCAHO/ CHAP/ HFAP (AOA)	CMS visit	Greater than 5% avg. standard (high or low)
Home infusion	No	N/A	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 Providers - 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	Facility	Yes	Medicare	JCAHO	CMS visit	Ask for plan of action; site visit corrections
Substance abuse - BH Inpatient, residential, or outpatient setting	Yes	Facility	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.