Skip to navigation Skip to content Skip to footer

Provider information validation

The information listed below is validated by UCare’s staff at the time of the initial credentialing application, recredentialing, and/or upon notification of applicable changes. To learn more about a provider’s credentials, use the Search Network tool.

Search network

Credentialed Practitioner Information Validation

 (Credentialed Practitioners Types) Item Description  Source Frequency of Validation Limitations 
Practitioner Full Name Complete name of practitioner as provided on initial credentialing application Credentialing application, demographic change form At initial credentialing, recredentialing, or upon receipt of a demographic change form Self-reported by provider
 
Gender Gender of practitioner Credentialing application, demographic change form At initial credentialing, recredentialing, or upon receipt of a demographic change form Not all providers provide this information. If provided is not used for credentialing purposes.
 Specialty The specialty or sub-specialty area in which the provider provides care Credentialing application, demographic change form At initial credentialing, recredentialing, or when a change in specialty is requested Certain specialties are not credential-types currently for UCare. Please see which provider types do not need credentialing which is available on our Provider Profile site.
Board Certification/Education Health care professionals such as doctors are board certified when they pass written, practical, and/or simulation tests that demonstrate their mastery of the basic knowledge and skills that define their specialty. Board certification indicates that doctors and other professionals are competent to practice medicine in their field. Different specialty organizations provide board certification. Some specialty boards require health care professionals to be recertified periodically.If the provider is not board certified, education must be verified Credentialing application, specialty boards, demographic change form At initial credentialing, recredentialing, or demographic change form when a change in specialty is requested UCare currently recognizes specialties via the Board entities on our Certification Organizations Page. If the practitioner is not Board Certified, their education and specialty training programs are verified with the educational institution during the credentialing process or when a specialty change is indicated via an online change form.
Hospital Affiliations The hospital(s) where provider has admitting privileges  Credentialing application At initial credentialing and recredentialing When providers change sites, their hospital affiliations may not be updated.
Medical Group Affiliations The medical group(s) that employs or is associated with the provider Credentialing application, demographic change form   At initial credentialing, recredentialing, or upon receipt of a demographic change form We are not always notified when a provider changes medical group affiliations.
Acceptance of New Patients Indicates if the provider is accepting new patients in his/her practice  Clinic Self-reported, not validated We may not be notified when this changes
Languages Spoken by the Practitioner Languages (except English) the practitioner speaks with sufficient fluency to treat patients who speak only that language Credentialing application At initial credentialing, recredentialing or upon receipt of a demographic change form Not all providers provide this information
Office Locations and Telephone Numbers The location and telephone number of all offices at which the practitioner works Credentialing application, demographic change form At initial credentialing, recredentialing and upon receipt of a demographic change form We may not be notified when a practitioner changes office locations.
Patient Centered Medical Home Recognition The National Committee for Quality Assurance’s (NCQA) Patient-Centered Medical Home recognition was developed to assess whether clinician practices are functioning as medical homes and recognize them for these efforts. The NCQA Patient-Centered Medical Home standards emphasize the use of systematic, patient-centered, coordinated care that supports access, communication and patient involvement. NCQA  Annually Learn more about NCQA’s efforts to improve primary care.

Hospital Information Validation

Hospital Information Validation Item Description  Source Frequency of Validation Limitations 
Facility Name Marketing name of facility Contract application At initial contracting, initial credentialing and recredentialing, or upon receipt of facility change form We may not be notified when a facility changes office name. 
Address and Telephone Number Street address and telephone number of the facility Contract application At initial contracting, initial credentialing and recredentialing, or upon receipt of facility change form We may not be notified when a facility changes an address.
Accreditation, CMS site review or UCare site review Accreditation is a voluntary process through which a facility is able to measure the quality of its services against nationally recognized standards. The goal of accreditation is to ensure that a facility meets standards that suggest it is delivering quality care. If a facility is not accredited, the facility must have a CMS site review or site review conducted by UCare. Contract application At initial contracting, initial credentialing and recredentialing If a facility is not accredited or has not had a CMS site visit in the last three years, then UCare must conduct the site review.
  Link to Medicare.gov Hospital Compare site specific to each facility CMS Hospital Compare Quarterly Quality Reporting based on CMS requirements
* The term “Provider” is used by UCare as a universal term that refers to all entities that provide health services.