Glossary

Specialty:

A specialty care doctor, or specialist, is a doctor who cares for a specific part of the body or for a specific disease. Specialty care doctors have extra training and/or education about that area of the body or that disease. Your primary care doctor will help you find a specialist when you need one. Some types of specialty care doctors in Neighborhood’s network are:gynecologists, allergists, or endocrinologists.

Specialty is the area of medicine in which this doctor is highly trained. This means that the doctor receives additional training in this area of medicine after graduation from medical school. Doctors tell us about their specialty when they complete their application to join Neighborhood and every 3 years thereafter. We check with the specialty training program or medical school to make sure the doctor completed all of his/her training. We also check to make sure the information is true at least every 3 years. This information is updated when we receive notification of changes from the doctor. Changes to this information between 3 yearcycles may not be reflected because the doctor may not tell us of the change until the next cycle.

Name, Gender, Languages Spoken by the Practitioner or Clinical Staff:

Doctors tell us their name, gender and the languages spoken by them or their clinical staff when they complete their application to join Neighborhood and every 3 years thereafter. This shows doctors who speak different languages or have someone in their office who speaks a different language. We do not check this information. Changes to this information between 3 year cycles may not be reflected because the doctor may not report changes until the next cycle. This information is updated when we receive notification of changes from the medical group or the doctor.

Board Certification with Expiration Date:

Board certification means that a doctor has completed additional training in an area of medicine and passed national exams and requirements for certification. Doctors tell us about their board certification and expiration date when they join Neighborhood and every 3 years thereafter. We check with the board to make sure the doctor has received his/her board certification. We also check to make sure the information is true at least every 3 years. Changes to this information between 3 year cycles may not be reflected because the doctor may not tell us of the changes until the next 3 year cycle. To find out the most up-to-date board certification information about this doctor or other doctors, please go to http://www.abms.org  and click on the “Is Your Doctor Certified?” link.

Accepting new patients:

Some doctors may not be able to see new patients. If not, you have to already be a patient of a doctor to go see him or her. Doctors tell us about this information when they complete their application to join Neighborhood and every 3 years thereafter. We do not check this information. This information is updated when we receive notification of changes from the medical group or the doctor. Changes to this information between 3 year cycles may not be reflected because the doctor may not tell us of the changes until the next cycle.

Hospital Affiliation:

This is the name of one or more hospitals in our network where doctors have admitting or attending privileges. This is the hospital that your doctor works with when his/her patients need hospital services. These are the hospitals that your doctor may send you to when you need non-emergency care. Doctors tell us about this information when they complete their application to join Neighborhood and every 3 years thereafter. Changes to this information between 3 year cycles may not be reflected because the doctor may not tell us of the changes until the next 3 year cycle. We check this information at least every 3 years.

Practitioner Office Location:

This includes street address and phone number of the place where the doctor sees patients. Doctors tell us their practice office locations when they complete their application to join Neighborhood and every 3 years thereafter. Changes to this information between 3 yearcycles may not be reflected because the doctor may not report changes until the next 3 yearcycle. This information is updated when we receive notification of changes from the medical group or the doctor.

Medical group affiliation:

Some doctors belong to a medical group that has more than one doctor in the office group location. This is the medical group that the doctor belongs to. Doctors tell us about this information when they complete their application to join Neighborhood and every 3 years thereafter. We do not check this information. Changes to this information between 3 yearcycles may not be reflected because the doctor may not tell us of the changes until the next 3 year cycle. This information is updated when we receive notification of changes from the medical group or the doctor.

Handicap Accessible:

Handicap accessible means that the office has special ramps and wide doors for wheelchairs to make access to the office easier. *Neighborhood staff does assess handicap accessibility at primary care doctor offices, OBGYN offices and urgent care centers at the time of network entry. 

Hospital Name, Location and Phone Number:

Each hospital tells us about this information when they complete their application to join Neighborhood and every 3 years thereafter. We check with the hospital to make sure the information is true at least every 3 years. Changes to this information between 3 year cycles may not be reflected because the hospital may not tell us of the change until the next 3 yearcycle.

Hospital Accreditation:

This means that the hospital has met the requirements and standards of a safety and quality of care inspection that was performed by the organization listed. Each hospital tells us about this information when they complete their application to join Neighborhood and every 3 years thereafter. We check with the accrediting entity to be sure the hospital is accredited. We also check with the accrediting entity to make sure the information is true at least every 3 years. Changes to this information between cycles may not be reflected because the hospital may not tell us of the change until the next 3 year cycle.

Hospital Quality Data:

You can use Hospital Compare to find hospitals and compare the quality of their care. Hospital Compare was created through the efforts of the Centers for Medicare & Medicaid Services (CMS), in collaboration with organizations representing consumers, hospitals, doctors, employers, accrediting organizations, and other federal agencies. The Hospital Compare overall rating summarizes up to 57 quality measures across seven areas of quality into a single star rating for each hospital. Not all hospitals report all measures and some hospitals may not be eligible for an overall rating. The hospital overall rating will be updated in July and December of each year.

Selection Criteria:

Neighborhood offers the same practitioner and hospital network to all its members. Neighborhood’s network includes all hospitals in the state of Rhode Island and a broad range of primary care practitioners and specialties such as cardiology, general surgery, pediatrician, internal medicine, neurology and obstetrics and gynecology. Neighborhood ensures that its network of practitioners and hospitals are accessible to members within a reasonable driving distance. To ensure that members have access to quality care, Neighborhood credentials all licensed practitioners before they can become effective in the network. All participating practitioners are re-credentialed every 3 years to ensure they continue to meet Neighborhood’s rigorous criteria for network participation. Neighborhood does not use quality measures, member experience measures, patient safety measures or cost-related measures to select practitioners or hospitals for participation in its network for Marketplace members.

To view the Accreditation status, visit The Joint Commission’s Quality Check® website at https://www.qualitycheck.org/.

To view the Accreditation status, visit the NIHO website at http://dnvaccreditation.com .