Provider Verification Process

Sutter Health Plus (SHP) participating medical groups (PMGs) are responsible for providing SHP accurate, current information regarding their physicians and healthcare providers such as nurse practitioners, labs and skilled nursing facilities. They notify SHP as new information becomes available. SHP’s online Provider Directory is updated weekly to reflect the most current information. SHP requires PMGs to verify the accuracy of the Provider Directory information on an annual basis.

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

You can also visit the California Department of Consumer Affairs to find out where a doctor attended medical school or information about postgraduate training (residency). Visit search.dca.ca.gov and search by doctor's name or license number.

When a provider joins or leaves a PMG, the PMG is required to notify SHP. PMGs are responsible for providing accurate, current information specific to their providers, including their name, address, phone number, and gender.

This field indicates if a provider is currently taking new patients. The PMG is required to notify SHP when it learns a provider is no longer accepting new patients or begins accepting new patients.

A physician who is board certified has received certification in a specialized area of medicine granted by the American Board of Medical Specialties (ABMS) or the American Osteopathic Association (AOA). Board certification(s) is verified by each PMG as part of its credentialing and re-credentialing process and is reported to SHP. To view the most current board certification status for a physician, visit the ABMS Certification Matters website at certificationmatters.org. To check the certification status of a Doctor of Osteopathic Medicine, call the AOA Member Service Center at (800) 621-1773 and select 1 from the menu options.

This field shows the network hospitals where a physician may admit or care for patients. PMGs validate hospital affiliation information during the credentialing and re-credentialing process. The PMGs report this information to SHP as well as any changes made to a physician’s hospital affiliation(s).

This field designates the PMG the provider is associated with. When a provider joins or leaves a SHP PMG, the PMG is required to notify SHP.

This field shows the languages, other than English, that the physician speaks and understands. Physicians self-report this information to their affiliated PMG at the time they are credentialed and re-credentialed. The PMGs report this information to SHP.

A specialty is a particular branch of medicine in which a provider 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. SHP’s PMGs validate specialty information during the credentialing and re-credentialing process and report all changes to SHP.

SHP verifies information provided by PMGs to ensure that each hospital is in good standing with state and federal regulatory bodies and accredited by an appropriate body. Verification takes place when a hospital joins the network (credentialing) and again every 36 months (re-credentialing).

Accreditation indicates that a hospital was evaluated and met the designated standards for quality healthcare and safety by an accrediting organization such as The Joint Commission (TJC). For more information on accreditation, visit the TJC website at jointcommission.org. SHP verifies the accuracy of name, location and accreditation status on an annual basis.

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