About Our Provider Directory Information
This describes how we verify and update information about the doctors and other health care providers in our Provider Directory. This information complies with National Committee for Quality Assurance (NCQA) standards for health plan provider directories.
Item | Description | Source | Frequency of Validation | Limitations |
---|---|---|---|---|
Practitioner Name | Credentialing application | Every three years | ||
Gender | Credentialing application | Self-reported, not validated | Not all practitioners provide this information | |
Specialty | The type of care or conditions a practitioner specializes in, such as family medicine, pediatrics, cardiology, or dermatology | American Board of Medical Specialties, the American Osteopathic Association and/or the American Medical Association | At credentialing and every three years during recredentialing or as soon as changes are reported | |
Medical Group Affiliations | The organizations, companies, or medical groups the practitioner is employed by or associated with. An organization or group may have more than one care site. | Credentialing application | At credentialing and every three years during recredentialing or as soon as changes are reported | Not all practitioners provide this information |
Hospital Affiliations | The hospitals where a practitioner is allowed to admit and care for patients | Credentialing application | At credentialing and every three years during recredentialing or as soon as changes are reported | Not all practitioners provide this information |
Hospital name and Location | Credentialing application | At credentialing and every three years during recredentialing or as soon as changes are reported | ||
Hospital Accreditation | An independent accreditation organization has recognized a hospital as meeting predetermined standards for quality of care and service. Two examples are the Joint Commission on Accreditation of Healthcare Organizations (Joint Commission) and National Integrated Accreditation for Healthcare Organizations (NIAHO). | Credentialing application, verified by Kaiser Permanente credentialing staff | At credentialing and every three years during recredentialing or as soon as changes are reported | |
Board Certification | Board certification involves rigorous testing by a recognized board of the American Board of Medical Specialties and is not required by most states. To verify a provider's board certification and status, visit the American Board of Medical Specialties Additional information about disciplinary actions or malpractice history can be obtained through the Washington State Department of Health or State of Idaho Board of Medicine | The American Board of Medical Specialties, American Osteopathic Association and/or American Medical Association | At credentialing and every three years during recredentialing or as soon as changes are reported | |
Accepting New Patients? | Indicates whether a physician is accepting new patients. A practitioner may have a full patient roster and cannot accept any new patients at this time. | Provider's office | As soon as changes are reported | |
Networks | Lists of providers whom members can receive health care services from using their health plan benefits | Defined by Kaiser Permanente | Annually | |
Languages Spoken | Languages, in addition to English, spoken by the practitioner and/or staff | Credentialing application | Self-reported, not validated | Practitioners and/or staff may speak languages they have not reported to us |
Office Location | The location the practitioner most often provides care at. | Credentialing application | At credentialing and every three years during recredentialing or as soon as changes are reported | Some practitioners may practice at more than one location |
NCQA Recognition | The National Committee for Quality Assurance (NCQA), through its Physician Practice Connections®/Patient Centered Medical Home™,* recognizes physician practices that emphasize patient-centered, coordinated care that supports access, communication, and patient involvement. | NCQA | Monthly | Recognition is awarded to all primary care practitioners at the care site. Practitioner location changes may not be immediately reflected. |
*Physician Practice Connections and Patient Centered Medical Home are registered trademarks of the National Committee for Quality Assurance.