CREDENTIALING

Credentialing

Since 1994, AMM has consistently passed health plan audits at stringent NCQA standard. AMM has direct electronic connectivity with the National Practitioner DataBank, American Medical Association, Medical Board of California, Medi-Medi Sanctions, and references the yearly updated American Board of Medical Specialties Directory and Federation of State Medical Boards. AMM monthly reviews the MBC Hot Sheet and Action Reports for physicians on file. All primary source verifications are done in house by AMM staff with no outsourcing. AMM conducts primary care and high volume specialist (including OB/GYN) physician office site visits using the DHS approved audit tool. AMM has also developed an extensive application database that simplifies the recredentialing process by giving member physicians a completed application for their review, update and signature only. AMM's proprietary program tracks missing and expired documents and provides summary worksheets that simplify the IPA Credentialing Committee's tracking and oversight responsibility. AMM's credentialing files have consistently received high marks from health plans for completeness and file integrity.