Credentialing Overview

Alma Integrity Standards promote our mission by: 1) Creating clear expectations for providers in terms of how to use the Alma platform and tools, and 2) Establishing an environment of safety and respect, while supporting providers in maintaining autonomy of their practices. To learn more about our integrity standards as a whole, please see What are Alma Integrity Standards?

This article covers Alma’s policies around Credentialing:

1. Responding to Alma: Re-Credentialing

Providers must respond to requests for re-credentialing in 30 days (specifically in terms of responding to Alma that CAQH profile has been updated). See Recredentialing at Alma to learn more about this process. 

2. Meeting and Maintaining Standards for Independent, Unrestricted Licensure 

All providers must maintain independent, unrestricted licensure status in all states in which they are practicing. 

3. Insurance Requirements

All providers must have and maintain professional liability insurance. For questions about professional liability insurance at Alma, see Getting Credentialed with Alma's Insurance Program

4. Timely and Accurate Submission of Information in the Credentialing Process

Providers must be timely and accurate in their submission of credentialing-related information to Alma. Specifically, they must notify the IPA of any sanction, censure, suspension, revocation, probation or other restriction imposed on their licenses or certifications within 5 days.

Providers must notify Alma of any circumstances that could impact their licensure status, including: 

  • Changes in liability insurance carriers or termination of, renewal of or any other material changes in Provider’s liability insurance, including reduction of limits, erosion of aggregate, changes in retention or non-payment of premium; 
  • Action which may result in or the actual suspension, sanction, revocation, condition, limitation, qualification of or other material restriction on Provider’s licenses or certifications; or any suspension, revocation, condition, limitation, qualification or other material restriction of Provider’s staff privileges at any licensed hospital, nursing home or other facility at which Provider has staff privileges during the term of this Agreement; 
  • A change in Provider’s name, address, ownership or Federal Tax I.D. 
  • indictment, arrest or conviction for a felony or for any criminal charge related to the practice of Provider’s profession; 
  • Claims or legal actions for professional negligence or bankruptcy; 
  • Provider’s termination, for cause, from any other provider network offered by any plan, including, without limitation, any healthcare service plan, health maintenance organization, health insurer, preferred provider organization, employer or trust fund; 
  • Any occurrence or condition that might materially impair the ability of Provider to perform its duties under this Agreement; or 
  • Any condition or circumstance that may pose a direct threat to the safety of Provider, patients, IPA or persons at Arlozorov9, Inc. 

Failure to notify Alma in the above situations could lead to unethical practices.

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