Verification Process

When a physician joins or leaves a WHA contracted Medical Group/IPA, the Group is required to notify WHA. Quarterly, the Medical Groups/IPAs review and confirm the accuracy of information specific to their physicians, including their name, address, phone number and gender.

Information about where your physician attended medical school or completed their residency is available by contacting your physician's medical group.

WHA's online Provider Directory is updated weekly to reflect the most current information.

Please report any inaccuracies listed in WHA's Provider Directory to WHA's Provider Relations Department at 844.870.2178 or directory@westernhealth.com.

If you are looking for a Behavioral/Mental Health, Chiropractic, Acupuncture, Dental or Eyewear provider, please see our Partners In Care.

WHA's contracted Medical Groups/IPAs are responsible for providing WHA accurate, current information regarding their physicians and healthcare providers. They notify WHA on a daily basis as new information becomes available. WHA's online Provider Directory is updated weekly to reflect the most current information. WHA requires that contracted Medical Groups/IPAs verify the accuracy of the Provider Directory information on a quarterly basis.

Verification of information about a physician's training, licensure, and board certification(s) is the responsibility of WHA's contracted Medical Groups/IPAs. Verification takes place when a physician initially joins a group (credentialing) and again every 36 months (re-credentialing). WHA carries out oversight activities to ensure that each contracted Medical Group/IPA meets and maintains national credentialing and re-credentialing standards.

WHA contracts directly with the hospitals listed in the WHA Provider Directory. Quarterly, WHA confirms the accuracy of hospital directory information, including but not limited to, licensure and accredited status.

This field indicates if a physician is currently taking new patients. The Medical Group/IPA notifies WHA when it learns a practitioner's practice is "closed" to new patients. Quarterly, WHA requires the Medical Groups/IPAs to validate this information.

To be accredited a hospital voluntarily submits to an ongoing evaluation process to determine if it meets the standards that have been established by an accrediting body. A hospital that is fully accredited by The Joint Commission is in full compliance with rigorous national healthcare quality and safety standards. Obtaining Joint Commission accreditation is validation of an organization's ongoing performance improvement efforts. Quarterly, WHA's contracted Medical Groups/IPAs are required to provide documents to support the accreditation of hospitals to which they refer WHA members. WHA verifies the accuracy of name, location and accreditation status on a quarterly basis.

• Verify a hospital's accreditation status
• View quality information on a hospital

A specialist who has successfully completed a residency program approved by the Accreditation Council for Graduate Medical Education (ACGME) in a specialty recognized by the American Board of Medical Specialties (ABMS) or by the American Osteopathic Association (AOA) and has been certified by an ABMS or AOA Member Board is considered board certified. Board certification(s) is verified by each contracted Medical Group/IPA as part of their credentialing and re-credentialing process and are reported to WHA. Quarterly, the contracted Medical Groups/IPAs must review and confirm the accuracy of information specific to their physician's, including board certification(s).

• Verify a physician's board certification

Members who would like to check the certification status of a Doctor of Osteopathic Medicine can contact the AOA Member Service Center at 800.621.1773 and select 1 from the menu options. All board certifications listed are those issued by an ABMS Board except as follows: If "AOB" appears before the board certification it is issued by, an AOA recognized board.

This field shows the hospitals where a physician may admit or care for patients. Physicians self-report this information to their affiliated Medical Group/IPA at the time they are credentialed and re-credentialed. The Medical Groups/IPAs report this information to WHA as well as any changes made to a physician's hospital affiliation(s). Quarterly, the Medical Group/IPA must review and confirm the accuracy of information specific to their physicians including their hospital affiliation(s).

Language(s) spoken by each physician is reported to WHA by the contracted Medical Groups/IPAs. If new information becomes known regarding a physician's ability to communicate in another language, the Medical Groups/IPAs will notify WHA. Language assistance is available at all of WHA's provider locations. If you have a specific language need let your physician's office know.

This field designates the Medical Groups/IPAs with whom the physician is associated. When a physician joins or leaves a WHA contracted Medical Group/IPA, the Group is required to notify WHA. Quarterly, the Medical Groups/IPAs review and confirm the accuracy of information specific to their physicians, including their Medical Group/IPA affiliation(s).

A specialty is a particular branch of medicine in which a physician focuses. A specialty may be based on a specific body system, such as the heart, a specific age group, such as pediatrics, or on a complex scientific technique used to diagnose or treat certain types of disorders. A specialist may or may not be board certified. WHA's contracted Medical Groups/IPAs validate specialty information during the credentialing and re-credentialing process and report all changes to WHA. Quarterly, the Medical Groups/IPAs must review and confirm the accuracy of information specific to their physicians' specialties.

The Patient-Centered Medical Home is a new way of organizing primary care that emphasizes care coordination and communication to transform primary care into "what patients want it to be." Medical homes use a care team approach to establish a partnership between the patient and their care team, provide enhanced access, proactive planning and follow-up and coordination across care settings.

• Verify NCQA Recognition

Provider(s), Provider Network includes: Physicians, Nurse Practitioners, Nurse Midwife, Physician Assistants, diagnostic imaging facilities, Skilled Nursing Facility, Inpatient Hospice, Inpatient Rehabilitation Facility, Ambulatory Surgery Centers and Hospitals, laboratories, pharmacies and urgent care centers.

Based on the line of business, members have access to one of four provider networks

• Network A – Small and Large Employer Group plans
• Network B – CalPERS members
• Network C – UCoP members
• Network D – Individual or  Individual and Family 

Western Health does not use quality, member experience or cost-related measures when selecting providers to participate in our network or in our Marketplace Silver Plan.

View details regarding WHA's Alternate Geographic Access Standards.

If you are looking for a  Behavioral/Mental Health, Chiropractic, Acupuncture, Dental or Eyewear provider, please see our Partners In Care.