A provider network is a list of physicians, hospitals and other providers that offer health care services to patients in a managed-care insurance plan. Managed-care plans are usually more affordable than other kinds of plans - but they limit your freedom to choose your own doctors. For participating Amerigroup health care providers or those interested in joining our provider network.
NCQA Provider Network Accreditation creates a framework for organizations to provide efficient, accurate and consistent network management and credentialing services.
A QUALITY IMPROVEMENT FRAMEWORK
Many health insurers rely on tiered and narrow networks to manage costs, and use third-party organizations to validate their networks. In response to these network designs, states and the federal government implemented regulations requiring a minimum level of access to care and services.
In addition, there are hospitals and doctors who are not included in every plan. Please make sure that you search the proper network for the most accurate results. You should contact the provider directly to confirm that they are in your plan network and that the desired service is covered by your plan.
The NCQA Provider Network Accreditation helps organizations maintain a high-quality network for members and clients by ensuring organizations:
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- Ensure appropriate client agreements.
- Verify credentials.
- Protect credentialing information.
- Ensure credentials peer review process.
- Evaluate contracted provider quality.
- Monitor sanctions and complaints.
- Use objective evidence.
- Maintain adequate network.
- Provide access to appointments.
- Facilitate the continuity and coordination of care.
- Provide physician directories.
Get Started
Provider Networks. When you choose a plan, you will typically have access to a specific provider network. Some networks may be larger than others or may include different choices of providers in your local area. Active network providers; Not a Magellan provider? Join the network; Provider discounts; Answers to frequently asked questions ©1999-2021 Magellan Health, Inc.
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