Credentialing

Committed to Building a Network of Excellence

MTI uses its credentialing process to provide clients with a selection of health care professionals who have demonstrated backgrounds consistent with the delivery of high quality, cost-effective health care. MTI has established criteria that are used to evaluate a provider’s credentials. The credentialing criteria serves as a foundation for determining a provider’s eligibility and continued eligibility on MTI’s network.

 

MTI requires all network providers to submit a written credentialing application prior to rendering services to or on behalf of MTI. The credentialing committee will request and verify items such as the applicant’s work history, current professional liability insurance, education, board certification (if applicable) history of loss, sanctions or other disciplinary activity. The process also consist of an on-site visit to assess the applicant’s location of practice or facility.

 

MTI maintains the confidentiality of vendors credentialing information with limited access for each provider through the credentialing process. Providers are expected to remain in compliance with credential criteria at all times.

 

Credentialing Requirements

Provider Type, Agency/Organization Legal & DBA Names

   •Tax ID# (TIN), Physical & Billing Address

   •Current Federal, State, Local Licensures

   •Current Professional/Liability Face Sheets for each policy

   •Current Accreditations

   •Covered Services with description of services

   •Service Areas (GSA) by counties

   •Hours of Operations & after hours (on call) Protocol

Key Management Staff And Contact Numbers

   •Current Medical Staff Listing

   •Credential Criteria for professional staff & independent contractor

Licensure & Certifications

   •State License/Registration #

   •Business/Vendor License #

   •Medicare Provider #

   •NPI Number/DEA # (if any)

   •Pharmacy Permit/License #

   •Bedding/Upholstery License (DME Provider only)

Accreditations-If Applicable

   •Accrediting Body

   •Accrediting Status

   •Expiration Date & Date of most recent survey

Liability And Professional Membership

   •Cancellation & non-renewed or restrictions by insurance carrier

Disciplinary Actions

   •Fines

   •Sanctions

   •Suspensions

   •Revoked, reductions or denials

Home Health Providers Only

   •Copy of HCFA/CMS State Licensure & Revisits

   •Copy of Corrective Action Plan

   •Copy of Current QI/UM Program with appropriate signature pages, QI/UM policies & procedures,

   •Annual reports and patient satisfaction surveys.

Diagnostic Imaging Providers Only

   •Verification to meet NCQA Standards is performed

   •ACR Accreditation

   •JCAHO Accreditation Certificates

   •Department of Health Bureau of Radiation Control Certificate (for x-rays)

   •Reading Radiologist Requirements

   •State Medical License

   •Professional Liability Insurance Declaration pages

   •DEA Certificate/ CDS Status

   •Board Certification Status

Diagnostic Imaging Providers Only

   •Full Criminal and OFAC background checks at inception and every 6 months thereafter

   •Department of Motor Vehicle background checks at inception and every 6 months thereafter

   •Vehicle Registrations

   •CPR/ EMS credentials verified at inception and yearly thereafter

   •State Certifications and licensing validation at inception and yearly thereafter

   •Drug screening attestation

   •Applicable Licenses and Certifications

   •Interpreter State / National Certification

Transportation And Language Providers Only

   •Full Criminal and OFAC background checks at inception and every 6 months thereafter

   •Department of Motor Vehicle background checks at inception and every 6 months thereafter

   •Vehicle Registrations

   •CPR/ EMS credentials verified at inception and yearly thereafter

   •State Certifications and licensing validation at inception and yearly thereafter

   •Drug screening attestation

   •Applicable Licenses and Certifications

   •Interpreter State / National Certification

QUICK LINKS

SERVICES

CALL US

800.553.2155