Specific Criteria for Providers

Specific Criteria for Physicians

  1. Physician is a graduate of a medical or osteopathic school located in the United States or Canada accredited by the Liaison Committee on Medical Education (LCME) or the AOA Bureau of Professional Education (BPE) or physicians who have graduated from a medical school in a country other than the U.S.A. or Canada possess an ECFMG Certificate.

  2. Physicians who prescribe medications have a current valid DEA and/or CDS in each state where care is provided. If the physician does not hold a DEA/CDS license or it is pending, there is documented process for allowing a participating physician with a valid DEA/CDS certificate to write all prescriptions.

  3. Physician has successfully completed a residency program approved by the Accreditation Council for Graduate Medical Education (ACGME) or its international equivalent in the specialty in which the applicant intends to practice. An exception to this may be extended under certain circumstances to residents providing medical care outside of their training programs.

  4. To be listed in a specialty, the physician is certified by the appropriate specialty board or admissible for examination for certification in a specialty recognized by the American Board of Medical Specialists (ABMS), The American Osteopathic Association (AOA), The Royal College of Physicians and Surgeons of Canada, or The College of Family Physicians of Canada. Allowances will be made for those physicians who have been “grandfathered.”

  5. Specialty practitioners applying to work as Primary Care Practitioners will be designated as General Practice.

Specific Criteria for Oral Surgeons

  1. Oral Surgeon is a graduate of a state school of dentistry or medicine.

  2. Oral Surgeons who prescribe medications has a current valid DEA and/or CDS in each state where care is provided. If the Oral Surgeon does not hold a DEA/CDS license or it is pending, there is a documented process for allowing a participating practitioner with a valid DEA/CDS certificate to write all prescriptions.

  3. Oral Surgeon has completed a specialty training program in oral surgery.

Specific Criteria for Optometrists

  1. Optometrist is a graduate of a state-accredited school of optometry.

  2. Optometrist has certification in state of practice.

  3. Participating optometrists without certification who have participated in the network prior 2002 will be grandfathered.

Specific Criteria for Podiatrists

  1. Podiatrist is a graduate of a college accredited by the Council on Podiatric Medical Education (CPME).

  2. Podiatrist is Board Certified or Board Qualified by the American Board of Podiatric Surgery or the American Board of Podiatric Orthopedics and Primary Podiatric Medicine.

  3. Podiatrist who prescribes medications has a current valid DEA and/or CDS in each state where care is provided. If the podiatrist does not hold a DEA/CDS license or it is pending, there is a documented process for allowing a participating practitioner with a valid DEA/CDS certificate to write all prescriptions.

  4. Podiatrist agrees to limit their services of podiatric medicine to the diagnosis of medical, mechanical, surgical treatment of the ailments as defined by the state in which licensed.

Specific Criteria for Mental Health Practitioners

  1. Only Psychiatrists, Doctoral Level Psychologists, or Licensed Master Level practitioners may practice independently.

  2. All Bachelor Level mental health practitioners will practice in a Rule 29 clinic, community mental health center or hospital.

  3. All practitioners will use the current “Diagnostic & Statistical Manual V Axial Diagnostic System” for diagnosis and care management.

  4. Non-physician prescribers shall practice under the scope of their licensure.

Specific Criteria for Physician Assistants

  1. Provider is board certified by the National Commission on Certification of Physician Assistants.

  2. Provider must practice under the direct supervision of a PreferredOne credentialed physician.

Specific Criteria for Nurse Practitioners

  1. Nurse Practitioner is certified as a Nurse Practitioner by an accredited national professional nursing organization accredited by the National Commission for Certifying Agencies (NCCA) as listed on Attachment CR001.2A.

  2. Nurse Practitioners will provide services through a PreferredOne contracted medical group.

Specific Criteria for Certified Registered Nurse Anesthetists

  1. Provider is a Registered Nurse and certified as a CRNA with a satisfactory completion of a certified course.

Specific Criteria for Certified Nurse Midwives

  1. Certified Nurse Midwife is certified through the American College of Nurse Midwives.

  2. CNMs who prescribe medications have a current valid DEA and/or CDS in each state where care is provided. If the CNM does not hold a DEA/CDS license or it is pending, there be documented process for allowing a participating practitioner with a valid DEA/CDS certificate to write all prescriptions.

  3. Independent Certified Nurse Midwives have a Joint Prescribing and Collaborative Practice Agreement with a PreferredOne participating OB/Gyn.