Ongoing Monitoring
Ongoing Required Reporting
| Weekly Reports | Monthly Report | |
|---|---|---|
| 1. Aetna | 2. Humana* | 1. Care N Care |
| 3. BCBS | 4. IMS | 2. Coalition |
| 5. Cigna | 6. Majoris | 3. Healthcare Highways |
| 7. Coastal | 8. Multiplan | 4. Parkland |
| 9. Galaxy | 10. UHC | 5. Superior |
| 11. HeathEZ | 12. USA | 6. Wellpoint |
| 13. HealthSmart | 14. WellCare |
*Humana exited the Commercial market effective 1/1/2025.
- Membership Transition: Current members will remain covered until their plan expires.
- Provider Agreement: Providers will continue to care for members until all members are fully transitioned.
- Medicare Plans: This change does NOT impact Medicare plans, which will continue to be offered.
If you are currently enrolled in the commercial PPO plan, you will remain a participating provider and continue caring for enrolled members until the membership ends. No action is required on your part at this time.
Required Ongoing Monitoring done by Genesis Physicians Group
Ongoing verification
This is essential to stay compliant with regulatory requirements and health plan policies. These are completed monthly at the end of each month.
TMB and NPDB
Credentialing is notified via email when new reports have been filed or settled. We will reach out to the practitioner for a statement and any additional information or documentation to present to Peer.
- CMS Preclusion List: exclusion list of individuals that are prohibited from participating in federal healthcare programs.
- Complaint Log – Issues, Practitioners, Clients and/or Payor Complaints
- CMS – Medicare Opt Out: provider chooses not to participate in Medicare.
- NPDB (National Practitioner Data Bank): tracks disciplinary actions
- OIG (Office of Inspector General)
- TX OIG (Texas Office of Inspector General)
- SAM (System for Award Management)
- TMB (Texas Medical Board)
- TDI (Texas Department of Insurance)
Ongoing Credentialing Cycle
Your credentials will be reverified every 3 years.
In between re-credentialing cycles, Genesis team conducts ongoing monitoring as per NCQA, CMS, and HealthPlan guidelines to maintain your HealthPlan enrollment and ensure there are no disruptions in your revenue cycle.
It’s essential to continue keeping your CAQH profile current.
