Credentialing: which providers do not require it.

Provider types and scenarios excluded from credentialing

Martin’s Point Health Care has specific policies regarding which providers require the full credentialing process and which are considered in network without undergoing our full credentialing procedure. Please review the following list of provider types and scenarios that do not require a credentialing application or advance notice of provider enrollment:

• Per diem providers: Because they provide temporary service, we do not list them in our directory.
• Part-time providers (less than weekly): Providers must be available weekly to be listed in our directory.
• Mid-level providers not serving as PCPs: Credentialing is required only for NPs in NP-only groups if that group’s specialty falls within a credentialed area.
• Chiropractors outside Maine and New Hampshire: Chiropractors in ME and NH for Medicare Advantage are credentialed; those outside are not.
• Non-office-based providers: Radiologists, pathologists, and anesthesiologists do not require credentialing.
• Rehabilitation therapists: PT, OT, SP, and SLT are paid at the facility level; facilities are credentialed, not individuals.
• Hospitalists: Strictly hospital-based providers without appointments (ER, urgent care) do not require credentialing.
• FM/IM providers in specialty settings: Credentialing only if practicing as a PCP.

These providers are considered in network when services are performed at a contracted group. Martin’s Point loads provider data from claims with an effective date 90 days prior to service.

Credentialing tip

If the provider specialty does not appear in the drop-down list at Provider DataPoint, it is a specialty that does not require credentialing or advance enrollment. The provider will be loaded from claims data. Always review our Credentialing page before submitting a provider to avoid unnecessary entry.