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Credentialing

Methodist Health Partners provides delegated credentialing services for all contracted payers following National Committee for Quality Assurance (NCQA) standards. Delegated credentialing relieves the provider office of duplicating efforts in filing applications to each payer.
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As a physician-hospital organization, participation in Methodist Health Partners, Inc. (MHP) is limited to qualified providers affiliated with:
  • Methodist Fremont Health (MFH)
  • Methodist Jennie Edmundson Memorial Hospital (MJEMH)
  • Methodist Women’s Hospital (MWH)
  • Nebraska Methodist Hospital (NMH)
  • Midwest Surgical Hospital

Credentialing is the process used to develop and maintain a network of practitioners qualified to deliver appropriate, medically necessary health care services to patients. The credentialing program involves the collection, verification, and review of information necessary for the selection and retention of practitioners for the MHP network.

The credentialing process typically includes researching practitioners education, licensure, National Practitioners Data Bank query, DEA certification, malpractice history, and past work history.

Methodist Health Partners provides a high standard of credentialing by following National Committee for Quality Assurance (NCQA) guidelines unless superseded by state or federal law.

Since 2003, MHP has maintained Delegated Credentialing Agreements with our contracted payers/networks, and we consistently receive the highest marks possible on our credentialing files. The Credentialing Committee is made up of at least four physicians with multi-specialty backgrounds and currently includes the below members.

Credentialing Committee Members

  • Michael Romano, MD, Chairman
  • Thomas McGinn, MD
  • Stephen Lim, MD
  • Heidi Hausmann, MD
  • Bill Lydiatt, MD
  • Eric Schulte, DO
Criteria For Participation

The following practitioners are eligible to participate in MHP:

  • Physicians (MDs and DOs)
  • Podiatrists (DPM)
  • Behavioral Health Practitioners, including:
    • Advance Practice Registered Nurses
    • Doctoral Psychologists who are state certified or state licensed
    • Master's level clinical social workers who are state certified or state licensed
    • Master's level clinical nurse specialists or psychiatric nurse practitioners who are state certified or state licensed
    • Other behavioral health care specialists who are licensed, certified or registered by the state to practice independently

Practitioners in group practices that do not include a participating MHP physician and are not employed by Nebraska Methodist Health System or an affiliate are only eligible to participate in MHP if all Practitioners in the group practice are considered an Eligible Practitioner as defined above.

The following Practitioners are eligible to participate in MHP if they provide services through a group practice  that includes a participating MHP physician or they are employed by Nebraska Methodist Health System or an affiliate:

  • Advanced Practice Registered Nurses (who are not Behavioral Health Practitioners)
  • Certified Nurse Midwives
  • Certified Registered Nurse Anesthetists
  • Physician Assistants
  • Optometrists
  • Chiropractors
  • Audiologist
  • Medical Nutrition Therapist
  • Physical Therapists
  • Occupational Therapists
  • Speech Therapists

Additional practitioner types are eligible for participation only upon review and approval by the MHP Board of Directors.

See Additional Credentialing Criteria

Ineligible Practitioners

The following are not eligible to be credentialed under MHP:

  • Locum Tenens Physicians
  • Temporary or Provisionally licensed practitioners
Contracted Payers
Methodist Health Partners has contracted with various payers to provide services to its members, employees or insured.
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Our experienced team provides value-based payer contracting, credentialing, and provider relations services to Methodist Health Partners providers.