Credentialing is the initial process used by a contracted Medical Group/IPA to review and evaluate the qualifications of a licensed independent practitioner prior to his/her provision of services to members. It is a rigorous process that involves primary source verification of licensure, education, certifications and other relevant information. WHA's contracted Medical Groups/IPAs must recredential their practitioners at least every 36 months and carryout ongoing monitoring of practitioners between recredentialing cycles.

An association made up of physicians who maintain their individual practices while agreeing as a group to accept the terms and conditions of a health plan's contracts and share risk for providing care to the health plan's members.

Licensure is the process by which a state admits physicians and other healthcare providers to the practice of medicine or their particular healthcare field. Licensure ensures that the person has the appropriate education and training and that they abide by recognized standards of professional conduct. WHA's contracted Medical Groups/IPAs have responsibility for ensuring their physicians and other healthcare providers are appropriately licensed. You may check the status of a physician license on the following website: http://www.mbc.ca.gov/Lookup.htm

"Primary Care Physicians" or "PCPs" are physicians licensed in medicine or osteopathy that specialize in pediatrics, internal medicine, general practice, family practice or other practitioners responsible for primary health care and preventive services. OB/GYN practitioners may be utilized as PCPs if they are designated as such by their medical group/IPA. Members must select a PCP to coordinate and oversee their health care services. The PCP status of each provider is verified at the time a provider is credentialed or recredentialed. PCP status is one of the factors the medical groups/IPAs report to WHA.*

This computer generated ID number is internally assigned by WHA for business purposes and other Health Plan related activities.

* Limitations to the accuracy of information in WHA's web-based or print Provider Directory would be the result of human or computer error in requesting information, responding to a request, a data entry error, or in the timeliness of reporting. WHA's print directories are limited to the information available at the time the directory is printed.