Credentialing Criteria
As a pre-requisite to contract, NetCare requires the completion of a Participating Provider Application for every physician wishing to become a NetCare Participating Provider.
Each time you add a new physician to your practice, you are required to have that physician complete a Participating Provider Application for our review, credentialing and record. This is especially important if that physician will be providing service and treating NetCare members.
The Participating Provider Application requires you to provide the following information and documentation:
- Board Certifications or eligibility
- Professional liability Insurance information
- Medicare Assignment
- Billing and Primary Address
- Hospital Affiliations
- Office or clinical hours
- Educational Background & Residency Information
- Malpractice Information
- Copy of Fee Schedule
- Copy of Professional Liability Insurance Policy
- Copy of Guam License Registration Certificate
- Complete Confidential Questionnaire
NetCare performs credentialing as a pre-requisite to contracting. This process involves verifying all physician credentials including educational background, residencies, hospital affiliations and malpractice information.
NetCare also re-credentials all providers under contract with NetCare at least every two years. The re-credentialing process includes verification of:
- Drug Enforcement Administration (DEA) registration number if the scope of practice would warrant the physician to have a DEA.
- Professional Liability – minimum amount required per occurrence and per aggregate
- Admitting privileges at Guam Memorial Hospital
- Clear report from the National Data Bank
- Board Certification or Board Eligible, if not Board Certified or Board Eligible, the physician must demonstrate appropriate training for specialty listed.
- Proof of medical license
- Sufficient information concerning any malpractice actions pending or resolved in the last five years.
- Completed confidential questionnaire
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