The Credentialing Process

All practitioners who wish to participate in the Neighborhood Health Plan of Rhode Island (Neighborhood) network must submit their credentials to Neighborhood for review by completing either a Neighborhood credentialing application or a printed copy of the Council for Affordable Quality Healthcare (CAQH).  Neighborhood assures that the process of credentialing practitioners is conducted in a confidential, non-discriminatory manner and decisions are based solely on standard credentialing requirements in addition to established recruitment standards.   Neighborhood's credentialing process ensures that listings in practitioner directories and other materials for members are consistent with credentialing data, including education, training, certification and specialty.  

Credentialing criteria are made available to applicants upon request. Credentialing is performed for all practitioners prior to network appointment and prior to listing them in member literature.  Before a practitioner’s contract can become effective, the Board of Directors must approve his/her application after review and recommendations by the Clinical Affairs Committee.  Neighborhood’s Medical Director is responsible for overseeing the credentialing program.

Neighborhood recredentials all participating practitioners every three (3) years to ensure that they continue to meet Neighborhood's credentialing standards.

Thank you for your interest in Neighborhood Health Plan of Rhode Island!

For more information on CAQH or to see if it is available in your area, please visit www.caqh.org.