For further questions regarding the credentialing , re-credentialing , or the credentialing / recredentialing appeal process , please call the Hometown Health Credentialing Department at ( 775 ) 982-3017 .
Facility Credentialing and Re-credentialing
Hometown Health conducts a formal and ongoing assessment of its organizational providers . An organizational provider is a facility or organization that provides services to Hometown Health and Senior Care Plus members . They include , but are not limited to : hospitals ( including inpatient rehabilitation facilities ); skilled nursing facilities and nursing homes ; free standing surgical centers ; home health agencies ; inpatient , residential , and ambulatory behavioral health facilities ; hospices ; trauma facilities ; clinical laboratories ; diagnostic imaging services , durable medical equipment ; and providers of end stage renal disease services .
Hometown Health confirms that the organizational providers are in good standing with state and federal regulatory bodies and have been reviewed and approved by an accrediting body , if appropriate . If the providers have not been approved by an accrediting body , they must meet Hometown Health ’ s standards as defined in Hometown Health ’ s Standards for Participation policy & procedure . Primary source verification of licensure is not required but the organization must provide a copy of the license and accreditation report or the information must be verified through alternative sources ( e . g . verification of accreditation status by searching list of accredited organization on the accrediting body ’ s Web site , such as “ The Joint Commission ” site or by verification of license status with the state licensing body ). A CMS or state review may be substituted for non-accredited organizational providers , unless an organization facility provider is in a rural area as defined by the U . S Census Bureau .
At a minimum of every three years , Hometown Health confirms that the organization providers continue to be in good standing with the state and federal regulatory bodies and , if applicable , are reviewed and approved by an accrediting body . Hometown Health “ Organizational Provider ” contracts provide for notice from the provider of any change in its Medicare approval , state licensure , or accreditation status .
Credentialing / Re-credentialing Denial Dispute Resolution
Hometown Health has an established process for the credentialing and re-credentialing of providers . This process includes the establishment of a process for appealing negative credentialing / re-credentialing decisions by the Medical Affairs Committee ( MAC ). Practitioners for all Hometown Health products whose applications have been denied will be informed of the following appeal rights and processes :
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