Verifying Provider Information

The online Provider Search tool is populated from an Intermountain Health database of physicians and other healthcare practitioners who meet both conditions below:

1. Completion of the Intermountain Health credentialing verification process that is repeated every three years. Not all types of healthcare practitioners are required to go through the Intermountain Health credentialing process. Healthcare practitioners who are not credentialed by Intermountain Health do not show up in the online provider directory.
2. Contractual participation with one or more Select Health insurance plans OR medical staff membership at the one or more Intermountain Health hospitals.

Intermountain and Select Health reserve the right to exclude certain medical specialties and certain medical provider for the online directory, for example, providers who choose not to be listed, providers who see patients on a walk-in basis only (such as InstaCare, KidsCare or WorkMed providers), hospitalist physicians who see hospital inpatients only.

Information about providers in the directory changes frequently and often without notice. Intermountain Health and Select Health have formal policies and procedures that address the collection and validation of directory information. However, responsibility falls on providers to report changes to their information so the database can be updated accordingly.

The information listed below is verified by Intermountain Health when a provider is initially credentialed. Updates to this information are also subsequently verified every three years thereafter.

• Name
• Gender
• Foreign language fluencies means and languages besides English in which a provider or clinical staff is able to speak with and understand patients. Member Advocates verify annually which languages are spoken by providers. This information can be obtained by calling the provider's offices and verifying that the information we have on file is accurate.
• Medical education and post-graduate residency and fellowship training.
• Accepting new patients refers to wether a provider's practice is open or closed to new patients or certain patient types. Member Advocates verify annually whether providers are accepting new patients. This information may vary by office location or Select Health insurance plan. It can be obtained by calling the provider's offices and verifying that the information we have on file is accurate.
• Medical speciality, meaning the speciality or specialities recognized by the American Board of Medical Specialities (ABMS) in which a provider was formally trained.
• Board certification, meaning the process whereby a licensed physician has elected to undergo an examination before a board of professional peers to establish expertise beyond regular medical licensure in an ABMS specialty or sub-specialty. This information applies to physicians only and not other types of healthcare practitioners. You may visit the ABMS website to verify a physician's board certifications.
• Hospital affiliations, meaning the Intermountain Health hospitals at which a provider holds active or courtesy medical staff privileges. Only providers who treat patients in a hospital setting will show hospital affiliations in the online directory. The listing is limited to Intermountain Health hospitals and may not be a comprehensive list of hospitals with which provider is affiliated, nor a comprehensive list of hospitals offered in the area.
• Office addresses, phone numbers, and medical group affiliations, meaning the name of a multi-specialty clinic that is associated with a provider's office address. Select Health has a policy and procedure to verify office locations and phone numbers when a provider joins a Select Health plan or network. Changes to a provider's office information is usually verified by Select Health upon notification of the change by a provider. Due to the frequency of changes to the office information among several thousand providers, not all changes are verified.
• Select Health plan participation, meaning the insurance plans or networks administrated by Select Health for which a provider has an active contract to treat members of the plan according the plan's fee schedule and polices. The list of plans is limited to those offered by Select Health and may not be a comprehensive list of plans accepted by a provider, nor comprehensive list of health insurers offered in the area.

The information listed below is self-reported by providers and is not verified or reviewed in the Intermountain Health credentialing process. Not all providers listed in the directory have supplied this information. Efforts to collect this information have be focused on physicians but will expand to other practitioner types in 2007.

• Professional memberships, meaning a provider's memberships in organized medical professional societies.
• Office hours, meaning the days of the week and the hours that a provider is open for seeing patients. Days and hours may vary by office location for providers with multiple offices.
• After-hours instructions, meaning the instructions a provider lists in the directory on how to get access to care after a provider's office is closed for the day.
• Practice focus, meaning any specific treatments, conditions, areas of the body, or patient types that a provider specifically focuses on or excludes from his or her practice. Providers are asked not to list anything that is outside of their formal training or conflicts with their hospital privileges.
• Patient education material, meaning general health or medical education documents that a provider chooses to make available to the public through the online directory.

The written standards for appointment wait times for primary care and behavioral health services must meet or exceed the minimum standards as follows:

• Urgently needed services or emergency—immediately;
• Services that are not emergency or urgently needed, but the enrollee requires medical attention—within 7 business days; and
• Routine and preventive care—within 30 business days.

Disclaimer

Inclusion of a provider in the online directory is not guarantee of coverage for any health insurance plan. Before receiving medical services, it is recommended that patients consult their health insurance plan to verify provider participation, referral and authorization requirements, and benefits including limitations and exclusions.

The online directory is not intended as a recommendation, referral, or endorsement of any particular provider, as a tool for verifying the credentials, qualifications, abilities, or availability of any such provider.

The online directory and any of the data, listings or other information contained therein may not be republished, sold, or re-purposed, in whole or in part, in any medium, for use in any other list of providers or for any purpose whatsoever, except for express use as a directory of Intermountain Health credentialed providers who contract with one or more Select Health insurance plans.

 

Network Transparency

We regularly monitor the location of our contracted networks against where our members live and work to ensure that the members have primary care physicians, behavioral health physicians, specialty physicians and hospitals within reasonable traveling distance. We evaluate these providers based on member complaints, member experience, clinical quality measures and appropriate use of healthcare resources. This helps us determine whether to add the provider or hospital to one or more of our networks.