Pennsylvania Code & Bulletin

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The Pennsylvania Code website reflects the Pennsylvania Code changes effective through 54 Pa.B. 1806 (March 30, 2024).

28 Pa. Code § 9.762. Credentialing standards.

§ 9.762. Credentialing standards.

 (a)  At a minimum, for PCPs and specialists, a plan shall verify the following credentialing elements:

   (1)  Current licensure.

   (2)  Education and training.

   (3)  Board certification status.

   (4)  Drug enforcement administration certification status.

   (5)  Current and adequate malpractice coverage.

   (6)  Malpractice claims history.

   (7)  Work history.

   (8)  Hospital privileges if the provider provides services at hospitals.

   (9)  Any other information the Department may require.

 (b)  A plan shall verify, at a minimum, for non-PCPs and nonspecialists, current licensure and malpractice coverage, to the extent licensure and coverage is required by State or Federal law.

Cross References

   This section cited in 28 Pa. Code §  9.763 (relating to nonphysician providers at facility, agency or organizations).

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