NIA maintains a credentialing process that enables the selection and retention of qualified and competent providers. This process includes assessment of whether or not individual health care professionals meet established objective criteria of credentials that meet or exceed standards set forth by national credentialing organizations, including NCQA, and other factors that reflect professional competency and quality.
The Credentialing Plan is a systematic and objective set of processes and policies setting forth credentialing activities. The Credentialing Plan includes assigning specific credentialing responsibilities to NIA administrative and professional staff, documenting compliance with the Plan, and reviewing and/or revising the plan regularly. The Credentialing Plan incorporates two functions: Initial Credentialing and Re-credentialing. Initial credentialing involves the evaluation of a provider’s credentials for beginning participation within Magellan’s provider network. Re-credentialing assesses providers’ on-going qualifications for continued participation with NIA.