AcuNET®
Credentialing Criteria, Policies and Procedures
Credentialing Criteria
All providers contracted with AcuNet must meet the following minimum
criteria:
- Possess an active, unencumbered license in the State of California
as a Licensed Acupuncturist.
- Licensed for a minimum of three years.
- Possess an active professional liability insurance policy with liability
limits of at least one million single and one million aggregate.
- Possess a general premises liability policy with limits of at least
$250,000.
- Speak and write English fluently.
- Practice in an non-residential office zoned for commercial use.
- Agree to use only disposable needles on AcuNet patients; reusable nedles
may not be used.
- Agree to only dispense herbal products which are in conformity with
applicable State and Federal laws. Such products include prepared formulas
which meet the Federal Food and Drug Administrations's (FDA) Good Manufacturing
Practices for Food, or the comparable regulatory approval in Taiwan or
Japan. Prepared formulas must also meet the labeling requirements of the
FDA. Crude herbs are acceptable unless 1) they contain parts of endangered
species as defined by the United States fish and Wildlife Service, or 2)
are on the California Food and Drug Branch list of toxic substances. Dispensing
of patent medication is not allowed.
- Each provider's office must be geographically located so it does not
provide an overlap in coverage due to an adequate number of existing AcuNet
providers being in close proximity to the provider applying for participation.
Adequate numbers of providers in each area are determined by the number
of people covered under existing and anticipated contracts. The network
is exanded to include additional providers as the anticipated volume of
patients increases and warrants expansion of the network.
Policies
- All applicants seeking participation in the AcuNet provider network
are reviewed in a consistent manner.
- The steps to the review process include:
- Review of the completed Application and requested documentation.
- Site visit to the provider's office and provider interview. All offices
must be located in office buildings.
- Primary Source Verification of the acupuncturists' licensure and professional
liability insurance.
- All patients records, certification requests, and other documents must
be written in English.
Procedures
- All providers being invited to participate in the AcuNet provider network
complete the Provider Application. The completed Applications and requested
copies of documentation of credentials are submitted to the AcuNet Credentialing
Coordinator.
- The Committee reviews the applications for completeness and follows
up, if necessary, with each provider to obtain additional information.
- The Coordinator enters the provider data into the Provider Database
and stores the Applications and documentation in a Provider File.
- When the files are complete, they are forwarded to the Credentialing
Committee for review.
- The Committee reviews each application and completes the Application
section of the Credentialing Worksheet.
- The Worksheets are copied and the copies mailed to the appropriate
Site Reviewer (based on location of the providers being reviewed).
- The site review/interview is conducted; the Site Reviewer completes
the Site Review/Interview section of the Credentialing Worksheet. The Worksheets
are then mailed back to the Committee.
- At the same time step #6 is occurring, Primary Source Verification
begins. Verification of state licensure is conducted by the Credentialing
Coordinator with the Acupuncture Committee of the Medical Board of California.
Verification of professional liability insurance is conducted with the
individual carriers. The Primary Source Verification section is completed
on the original Credentialing Worksheet.
- The copy and original Credentialing Worksheet are stored in the File.
The additional data obtained in entered into the Provider Database.
- The Credentialing Committee reviews the completed file and renders
its final decision as to whether the provider is accepted into the network.
All contracts for accepted providers are executed by AcuNet. One copy is
stored in the provider's file.
- A letter indicating the Committee's decision is sent to the Applicant.
If the provider is accepted, a fully executed copy of the contract and
the Provider Manual is included with the letter.
Recredentialing Procedures
- It is critical that AcuNet receive updated documentation (current copy
of license, professional liability policy, etc.) prior to the expiration
date of the previously submitted documentation. Therefore, please request
renewal of your credentials immediately upon receiving notice that termination
is forthcoming.
- The following updated documentation must be submitted to AcuNet either
via fax or U.S. Mail as soon as the documentation is received by the Provider:
- Copy of wallet-size license.
- Copy of professional liability certificate of coverage or facesheet.
- Copy of general business/premises liability certificate of coverage
or facesheet.
- Every two years, AcuNet will conduct the following formal recredentialing
activities:
- Primary Source Verification with the licensing board and professional
liability carriers.
- Site visit to the provider's office.
- Obtain signed notice from the provider regarding his/her continued
competency to practice acupuncture and verifying certain demographic information.