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Credentialing

In order to provide services to First Choice members as a participating provider, practitioners must first be credentialed by Select Health of South Carolina.

Select Health maintains and adheres to all applicable state and federal standards and regulations, South Carolina Department of Health and Human Services requirements and NCQA accreditation requirements governing credentialing and re-credentialing functions.

The following types of practitioners require credentialing and re-credentialing:

  • Medical Doctors (MD)
  • Doctors Osteopathic Medicine (DO)
  • Doctors of Podiatric Medicine (DPM)
  • Doctors of Chiropractic (DC)
  • Doctors of Optometry (OD)
  • Doctors of Philosophy (PHD)
  • Certified Nurse Midwives (CNM)
  • Nurse Practitioners (NP)
  • Audiologists
  • Occupational Therapists
  • Physical Therapists
  • Speech and Language Therapists
  • Behavioral Health Care Professionals
  • Physician Assistants
  • Registered Dieticians

The scope of the Credentials Program includes all health care professionals and non-physician health care professionals who have an independent relationship with the organization and who see members outside the inpatient hospital setting or outside of ambulatory freestanding facilities.

Health care professionals who have been credentialed through a plan delegate are not included in this scope.

All health care professionals, ancillary providers and organizational providers such as hospitals and home health groups are re-credentialed every three years.

Credentialing process

Providers can use the online credentialing application through Council for Affordable Quality Healthcare Inc. (CAQH). However, additional documents that will not be found in your CAQH record are required. Please contact your Provider Network account executive for the additional documents required. Simply having a CAQH record does not initiate the credentialing process with Select Health.

To learn more about the credentialing process, please refer to your provider manual (PDF). You can also call Provider Services at 1-800-741-6605. Please submit all completed credentialing documents to your local account executive (PDF).

Practitioner and organizational provider credentialing rights

After the submission of the application, health care providers have the following rights:

  • To review information submitted to support their credentialing applications, with the exception of references, recommendations, and peer-protected information obtained by the plan.
  • To correct erroneous information. When information obtained by the Credentialing department varies substantially from information provided by the provider, the Credentialing department will notify the provider to correct the discrepancy.
  • To be informed, upon request, of the status of their credentialing or recredentialing applications.
  • To be notified within 60 calendar days of the Credentialing Committee or Medical Director review decision.
  • To appeal any recredentialing denial within 30 calendar days of receiving written notification of the decision.
  • To know that all documentation and other information received for the purpose of credentialing and recredentialing is considered confidential and is stored in a secure location that is only accessed by authorized plan associates.
  • To receive notification of these rights.

To request any of the above, providers should contact the Select Health of South Carolina Credentialing department at Select Health of South Carolina, Attn: Credentialing Department, 200 Stevens Drive, Philadelphia, PA 19113.