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Requirements cover sanctions and felony-free status, review of NPDB/OIG/SAM/Medicheck, Medicaid MAID and NPI numbers, board certification or board-eligible conditions, documentation of CMEs, and time-windowed claims history and work-gap explanations.",{"@graph":69,"@context":115},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/credentialing-standards/327789/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/credentialing-standards/327789.png","ImageObject",300,407,{"name":92,"@type":93},"wps_ap_test_251126_0180","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-22","2026-09-21",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",11,{"@type":107,"mainEntity":108},"FAQPage",[109],{"name":110,"@type":111,"acceptedAnswer":112},"What are the board certification expectations and exceptions?","Question",{"text":113,"@type":114},"Specialist practitioners must be board certified in the specialty or be board eligible during a probationary period between approved specialty training completion and passing the Specialty Certifying Examination. Exceptions may be considered by the credentials committee based on defined business need, peer review case-by-case discussion, documented plan to take the boards, established specialty standing, or foreign training/foreign board certification not listed in the appendix.","Answer","https://schema.org",{"og:url":83,"og:type":117,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":119,"canonical":83},"index,follow",{"doc_id":121,"site_id":62},327789,1790025564,{"code":4,"msg":5,"data":124},{"doc_id":121,"user_id":125,"nickname":92,"user_avatar":126,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":127,"file_id":128,"file_url":129,"file_type":130,"file_size":131,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":24,"language":132,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":133,"faqs":134,"seo_title":135,"seo_description":67,"update_tm":136,"read_time":137},8796095027276,"https://avatar.qwps.com/avatar/d3BzX2FwX3Rlc3RfMjUxMTI2XzAxODA=","1. Complete and sign a Jefferson Health Plans Provider Data Collection Form (PDCF), which includes Principles of Ethics attestation. This applies to professional providers only.  \n2. Complete and sign and date a Participating Provider Application, PA Standard Application or CAQH, Jefferson Health Plans Ancillary, Jefferson Health Plans Facility. This must include all questions answered regarding the following: reasons for inability to perform essential functions of position without accommodations, lack of present illegal drug use, history of loss of license and felony convictions, history of loss of limitations or privileges or disciplinary action, attestation to the correctness of the application and signature within 180 days.  \n3. Submit one signed and dated Health Partners Plans Participating Provider Agreement. *  \n4. Submit a current, unrestricted license to practice in the Commonwealth of Pennsylvania or License to practice within the State of practicing medicine, if not Pennsylvania. A current active license indicates all continuing education requirements have been met. Jefferson Health Plans does recognize an “On Probation” status license as an active license, however, any provider with this status will be deferred to our credentials committee for decision making. If the license is current and active but has had a sanction action taken on behalf of other states or within PA, it will not need credentials committee review.  \n5. Submit a current DEA or CDS certificate with a Pennsylvania address or in the State of practicing medicine if not Pennsylvania, if applicable. *  \n6. Submit evidence of professional liability insurance with limits of liability as required by the Commonwealth of Pennsylvania or within the State of practicing medicine if not Pennsylvania.  \n7. There is a 5-year history for initial credentialing and 3-year for Re-credentialing of professional liability claims that are open, or settlement paid by or on behalf of the provider.  \n8. Providers who render services in a hospital setting are required to have an affiliation at a hospital participating in the Jefferson Health Plans network for each Jefferson Health Plans line of business which the provider participates. In place of maintaining a hospital affiliation at a Jefferson Health Plans participating hospital the provider may enter into a covering agreement with another Jefferson Health Plans participating provider in the same practicing specialty who has a hospital affiliation at a Jefferson Health Plans participating hospital.  \nPrimary Care Providers (PCPs) are not required to maintain an active hospital affiliation.  \n9. All providers must be free of felony convictions and preclusion from participation. Review of NPDB, OIG, SAM and Medicheck will be conducted at the time of initial credentialing and recredentialing.  \n10. All providers must provide current Pennsylvania State Medicaid Numbers (MAID), for the individual provider and group/practice level, if applicable.  \n11. All providers must provide current vendor (billing) and individual NPI numbers.  \n12. Specialist practitioners must be board certified in the specialty for which they are applying; or considered “board eligible” which is a probationary period allowed between the completion of an approved specialty training program and passing the Specialty Certifying Examination. Please review the below appendix for a listing of Boards recognized by Jefferson Health Plans. The following exceptions to this requirement will be considered by the credentials committee however, it does not secure approval into the Jefferson Health Plans network. *  \n􀂙 There is a business need defined by Jefferson Health Plans determined by Leadership to meet the limited adequacies in these three areas  \n• Language / geographic zones / limited specialty needs in their group  \n􀂙 Committee Peer review needed which is a case-by-case discussion  \n• The provider submits a documented plan to sit for the boards within a reaso","cbCaikZU05tuVkl0","https://ap.wps.com/l/cbCaikZU05tuVkl0","pdf",453524,"English","# Required Forms and Attestations\n## Provider applications and agreements\n## Ethics attestation and certification within time limits\n# Licensure and Controlled Substances\n## Unrestricted Pennsylvania or applicable state license\n## DEA/CDS certificate requirements\n# Insurance and Claims History\n## Professional liability insurance evidence\n## Five-year look back and open/settled claims review\n# Hospital Affiliation and Specialty Requirements\n## Hospital affiliation or covering agreement rules\n## Board certification/board eligible criteria\n# Compliance, Identifiers, and Documentation\n## Felony conviction and participation exclusions\n## NPDB, OIG, SAM, and Medicheck review\n## Medicaid MAID and NPI numbers\n## CMEs and work-history gap explanation\n# Facility, Medicare, and Role-Specific Agreements\n## Facility accreditation and DOH survey documentation\n## Medicare number and opt-out/preclusion exclusions\n## Collaborative agreements for CRNPs/CNMs and PA-C protocols","[{\"question\":\"What are the board certification expectations and exceptions?\",\"answer\":\"Specialist practitioners must be board certified in the specialty or be board eligible during a probationary period between approved specialty training completion and passing the Specialty Certifying Examination. Exceptions may be considered by the credentials committee based on defined business need, peer review case-by-case discussion, documented plan to take the boards, established specialty standing, or foreign training/foreign board certification not listed in the appendix.\"}]","Credentialing Standards | PDF",1789978044,13]