Glossary

Definitions of terms used to search for providers online. 

Term Definition How is this information collected Resulting limitations How often this information is validated
Provider Name Provider's name The provider tells us his or her name The provider tells us his or her name. We do not ensure that information is accurate at that time. We collect this information during recredentialing. That happens every 2 years. We do not ensure that information is accurate, but staff do verify with the provider through routine provider visits at least once every 3 years.
Gender Male or Female The provider tells us his or her gender. The provider tells us his or her gender. We do not ensure that information is accurate at that time. Staff verify with the provider through routine provider visits at least once every 3 years.
Specialty The area of medicine that a health care provider has a special interest in. The provider gives us that information. The provider gives us that information. We verify this information during initial credentialing, and during recredentialing. That happens every 2 years. We also make sure it's correct whenever the provider tells us about a change in hospital affiliation. Staff also verify with the provider through routine provider visits at least once every 3 years.
Hospital Affiliation(s) The hospital(s) where the health care provider can admit patients. The provider gives us that information. The hospital makes sure it's accurate. We rely on the hospital to keep its records updated. We make sure this information is correct during recredentialing. That happens every 2 years. We also make sure it's correct whenever the provider tells us about a change in hospital affiliation. Staff also verify with the provider through routine provider visits at least once every 3 years.
Medical Group Affiliation(s), if applicable If applicable, the group of clinicians the provider works with. If applicable, the provider or provider group gives us that information. If applicable, the provider gives us that information. We do not ensure that information is accurate at that time. We collect this information during recredentialing. That happens every 2 years. We do not ensure that information is accurate. Staff verify medical group affiliation with the provider through routine provider visits at least once every 3 years.
Board Certification A certification for health care providers who are trained in a medical specialty. Also given to those who pass special exams to prove how much they know about a specialty. Providers need to be board certified or seeking board certification. The provider gives us the information on the credentialing application. It is verified by the specialty board. We rely on the specialty board to keep its records updated. We make sure the information is correct at each credentialing cycle. Then we make sure it's still correct each year if board certification ends between recredentialing cycles.
Accepting New Patients The provider will see new patients who aren't already seen by him or her. The provider gives us that information. The provider gives us that information. We do not ensure that information is accurate at that time. We collect the information when the provider joins the network and when the provider wants to change new-patient status. Staff also verify with the provider through routine provider visits at least once every 3 years.
Languages Languages spoken by the provider. The provider gives us that information. The provider gives us that information. We do not ensure that information is accurate at that time. Staff verify languages spoken with the provider through routine provider visits at least once every 3 years.
Office Locations Where the provider sees patients. The provider gives us that information. The provider gives us that information. We do not ensure that information is accurate at that time. We collect this information during recredentialing. That happens every 2 years. We do not ensure that information is accurate. Staff verify languages spoken with the provider through routine provider visits at least once every 3 years.
Facility Name Name of a facility like a hospital or nursing home The facility gives us that information. The name the facility gives us is compared to the name on the state license to make sure it's correct. We rely on the state licensing agency to keep their records updated. We make sure the information is correct during recredentialing. That happens every 3 years.
Location Physical address of the facility The facility gives us that information. The facility gives us that information. We do not ensure that information is accurate at that time. We make sure the information is correct during recredentialing. That happens every 3 years.
Accreditation When a special outside group decides that a medical facility meets certain standards of care. The medical facility gives us the information on the credentialing application. It is verified by the accrediting group. We rely on the accrediting group to keep their records updated. We make sure the information is correct at the first credentialing. Then it's checked again during recredentialing. That happens every 3 years.