Glossary of terms
What is NAME ?
The name represents the legal name under which the provider is licensed.
Provider information is collected and validated through the initial and recredentialing application process. Provider names are reviewed at least every two years. Changes to provider names are updated after being verified upon notification by the provider.What is ADDRESS?
The address represents the physical address of the provider.
Provider information is collected and validated through the application process. Provider addresses are maintained on a regular basis and are verified twice a year. Changes to provider addresses are updated upon notification by the provider.What is PHONE?
The phone represents the contact phone number of the provider.
Provider information is collected and validated through the application process. Provider addresses are maintained on a regular basis. Changes to provider addresses are updated upon notification by the provider.What is SPECIALTY?
Specialty represents the area of medicine that the practitioner was formally trained in and credentialed by CHG.
Practitioner information is collected and validated through the application process and primary source verification. CHG verifies board certification status, using nationally-recognized specialty boards, at the time of initial credentialing and at re-credentialing which is conducted every 36 months.What is BOARD CERTIFICATION?
Board certification demonstrates a physician exceptional expertise in a particular specialty and/or subspecialty of medical practice. When a physician is board certified, this recognition represents the physician’s commitment and expertise in consistently achieving superior clinical outcomes in a responsive, patient-focused setting.
Practitioner information is collected and validated through the application process and primary source verification. CHG verifies board certification status, using nationally-recognized specialty boards, at the time of initial credentialing and at re-credentialing which is conducted every 36 months.The American Board of Medical Specialties (ABMS) is a not-for-profit organization that assists 24 approved medical specialty boards in the development and use of standards in the ongoing evaluation and certification of physicians. If the physician’s degree is MD, you may verify their certification from the ABMS link below.
The ABMS verification web page is located at www.certificationmatters.org and provides consumers the ability to verify a physician’s board certification by a link which directs the consumer to a search screen. The user will need to create a log-in account to access the search engine. Once the account is created, the user enters the required information (i.e., Provider First and Last Name, City and State) and the results are displayed.
Many physicians with a DO (Doctor of Osteopathy) degree are board certified through ABMS above. Some are board certified through American Osteopathic Association (AOA). The AOA verification web page is located at www.doctorsthatdo.org.You can enter the city and state or zip to locate AOA Board certified physicians in that specific area.
What is Gender?
Gender represents the gender of the practitioner.
Practitioner information is collected and validated through the application process.What is ACCEPTING NEW PATIENTS?
If the practitioner’s office is no longer accepting new patients, this means that the practitioner is not available for assignment or referral of new patients. However, the practitioners may make an exception if you are a former patient. Please contact Customer Service at (619) 498-6464 or (888) 244-4430 for assistance.
Practitioner information is collected and validated through the application process. Practitioner panels are maintained on a regular basis. Changes to practitioner panels are updated upon notification by the practitioners. The panel status is verified twice a yearWhat is Languages?
Languages represent the practitioner language(s) in which the practitioner is fluent.
Practitioner information is collected and validated through the application process.Practitioner languages are reviewed and verified twice a year. Changes to practitioner language capabilities are updated upon notification by the practitioner.
What is AGE RESTRICTION?
A practitioner may limit his or her practice. For example, if Ages Accepted indicates “no restrictions”, the practitioner will see patients of all ages. If Ages Accepted indicates “16 and up”, the practitioner is limiting his or her practice to patients age 16 years and older. If Ages Accepted indicates 0 - 15, the practitioner will only see patients ranging in age from 0 to 15 years old.
Practitioner information is collected and validated through the application process. Practitioner information is reviewed and verified twice a year. Changes to practitioner age restrictions are updated upon notification by the practitioner.What is MEDICAL GROUP/IPA?
Medical Group/IPA indicate those practices in which a practitioner is associated.
Practitioner information is collected and validated through the application process. Practitioner affiliations are reviewed and verified twice a year. Changes to practitioner affiliations are updated upon notification by the practitioner.What is HOSPITAL AFFILIATIONS?
Hospital affiliations represent the hospital(s) at which the practitioner currently has privileges.
Practitioner information is collected and validated through the application process. Practitioner hospital affiliations are maintained on a regular basis. Changes to practitioner hospital affiliations are updated upon notification by the practitioner. Additionally, CHG verifies practitioner hospital affiliations at the time of credentialing and at re-credentialing which is conducted every 36 months.What is Accreditation and Quality Report?
Earning a national accreditation or certification signifies a devotion to patient safety and quality care. This link will show the accreditation status and quality data for the facility.
Quality data information is collected and verified during the initial credentialing and at re-credentialing which is conducted every 36 months.What is a primary care physician?
This is a doctor who specializes in:
- General Practice
- Family Practice
- Internal Medicine
- Pediatrics (children)
- Obstetrics/Gynecology (OB/GYN)
What is a specialist physician?
A specialist physician is a doctor who has completed advanced education and training in a specific field of medicine.
What is a Mental Health provider?
Mental health providers are professionals who diagnose mental health conditions and provides treatment.
What is a Allied Health provider?
Allied Health is a term used to describe the broad range of health professionals who are not doctors, dentists, nurses or physician assistants. Allied health professionals aim to prevent, diagnose and treat a range of conditions and illnesses and often work within a multidisciplinary health team to provide the best patient outcomes.
What is a Non-Physician Medical Practitioner (NPMP)?
Non Physician Medical Practitioner means a nurse practitioner, certified nurse midwife, or physician assistant authorized to provide care under physician supervision.
What is a Vision Service Plan provider?
A Vision Service Plan (VSP) provider provides vision services for our members.