Use of Board Certification and Recertification of Pediatricians in Health Plan Credentialing Policies - American Board of Medical Specialties

This study researches the credentialing policies health plans use in regards to board certification and recertification. The study specifically focuses on general pediatricians and pediatric subspecialists. Out of the roughly 200 respondents, a vast majority did not require general pediatricians to be board certified at the point of initial credentialing. Furthermore, less than half require general pediatricians ever to be board certified. For subspecialists, only 15% required certification at initial contract and 26% required certification at some point. Additionally, a majority of respondents said they would allow subspecialists to bill as subspecialist even if their certification as since expired. The authors believe that these results raise issues surrounding whether or not health plans can effectively guarantee the competency of their physicians.

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