You may have noticed that recently, PREFERRED has become
more diligent in confirming the termination of providers who are no longer eligible to participate under
PREFERRED’s healthplan/PPO agreements. Providers are "terminated"
for various reasons:
Failure to meet credentialing requirements: PREFERRED surpasses nationally
recognized standards for credentialing and recredentialing. Providers who fail to meet or maintain
these standards are eliminated from the network. All credentialing issues are reviewed by
PREFERRED’s Credentialing Committee, which is comprised of physical,
occupational, and speech therapists who are members in good standing in our network.
Quality/Compliance: Through ongoing monitoring and random audits, PREFERRED
identifies providers who are non-compliant with certain quality standards. Termination for
Quality/Compliance reasons involve issues such as: license sanctions, over utilization,
excessive or inappropriate billing practices, unethical conduct, negligence, or malpractice
activity. All Quality issues are reviewed by PREFERRED’s
Advisory Board, which is comprised of physical, occupational, and speech therapists who are
members in good standing in our network.
Provider opt-out: Providers may choose to opt out of participation with a certain healthplan or
PPO, or may opt to terminate from PREFERRED’s network completely.
At this point, the provider has made the decision to no longer accept the terms of
PREFERRED’s agreement. It is important to remember that our
request to “terminate” the provider refers ONLY to the process of de-linking
them from the PREFERRED agreement. Pre-existing agreements, direct
agreements, or agreements through other sources should not be affected by
PREFERRED’s termination request.
Once a provider is terminated from our network, for whatever reason, PREFERRED no longer
monitors their credentials, and cannot validate quality and compliance. After PREFERRED
submits the termination request, it is the healthplan or PPO’s responsibility to remove
or de-link that provider within a reasonable time frame.
For all of you who process our data changes, we sincerely appreciate all that you do.
It is through your efforts and your diligence that the integrity of our provider data in
your systems is ensured! The PREFERRED Network represents the
“Gold Standard” in private practice physical, occupational, and speech therapy
clinics. Thank you for everything you do to help us maintain that status!
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