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Our focus is physician-led, quality health coverage for members.
General Screening Criteria for Physicians
You must have:
A post-secondary education degree and, if applicable, post graduate training appropriate to your specialty
Current, unrestricted license(s) to practice the practitioner's specialty(ies);
Current Drug Enforcement Agency certificate, if applicable
Current certificate of insurance indicating professional liability insurance coverage (state licensure board minimum required limits)
For M.D./D.O.s, board certification or proof of board qualification/eligibility in the orderly process of obtaining board certification by a board accredited by the American Board of Medical Specialties or the American Osteopathic Association. Physicians who are not board certified are required to achieve board certification within four (4) years of either the date of board qualification/eligibility or the date of empanelment by the Health Plan, whichever is later, to qualify for continued participation.
Additional Requirements for Surgical Specialties
Surgical specialists must:
Obtain and maintain hospital admitting/surgical privileges at a Geisinger Health Plan participating hospital appropriate to their practicing specialty(ies).
Obtain and maintain hospital admitting privileges appropriate to their practicing specialty(ies) or provide a written documented coverage arrangement with another Geisigner Health Plan participating physician with admitting privileges at a Health Plan participating hospital.
Additional Requirements for Primary Care Physicians (PCPs)
To qualify as a primary care physician (PCP), the physician must:
Practice as a PCP at least 50% of the time in which the physician engages in the practice of medicine
Be available to see members a minimum of 20 hours per week;
Have focused his/her practice of medicine in general practice, family practice, general internal medicine and/or general pediatrics for at least 2 years prior to applying to the Health Plan to become a PCP.
New graduates from subspecialty fellowship training programs under the aforementioned specialties are excluded from this requirement (i.e., a new graduate from a cardiology fellowship program may qualify as a PCP in internal medicine).
Physician Application & On-site Review
An on-site office and medical record review will be conducted prior to full participation with Geisinger Health Plan in accordance with the National Committee for Quality Assurance (NCQA) guidelines. Satisfactory completion of these requirements, along with your application and participation materials, will be reviewed by the Geisinger Health Plan Credentials Committee.
Find Out More
Call Geisinger Health Plan credentialing at (800) 876-5357 or contact your Geisinger Health Plan provider relations representative.
