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Credentialing & Recredentialing

What is the credentialing and re-credentialing process for network providers? 

Davis Vision’s selection of the most qualified ophthalmologists and optometrists in our network is accomplished through an extensive application and NCQA-certified credentialing process.

Davis Vision collects, validates and submits all documenation, history and quality data for review by the Credentialing Committee. Source verification of education, licensure, board certification and DEA registration (where applicable) is obtained and the National Practitioner Data Bank is queried for all applicants. The Credentialing Committee conducts an assessment of each provider’s credentials based upon pre-established guidelines of professional qualifications and office qualifications deemed necessary to provide quality patient care.

The credentialing and recredentialing of providers is ongoing to ensure to quality of care provided by our network providers. Recredentialing, conducted every three years, is based on a review of updated documentation (licensure, National Practitioner Data Bank inquiry, malpractice history, etc.), as well as reports generated through the patient satisfaction feedback mechanism and Davis Vision’s Quality Assurance Program, including site visits.


Complete Application Description

  1. CAQH application - complete and attested no greater than 120 days
    • a.Disclosure Questions (Section 8) - Answer all questions and for any “Yes” response, provide an explanation on the Supplemental Disclosure Question Explanation Form
    • b.If you have any open or closed malpractice cases within the last 10 years, provide an explanation regarding your malpractice claims history, including the reason for the claim(s) and their disposition
  2. Curriculum Vitae (resume)
  3. Copy of license(s) - all states in which practitioner is actively seeing patients
  4. Copy of DEA (if applicable) – DEA must reflect the current state practitioner is seeing patients for al MDs
  5. Copy of controlled substance, if applicable
  6. Copy of board certification, if applicable
  7. Professional Liability Insurance - minimum $1 million per occurrence/$3 million aggregate
  8. National Practitioner Identified (NPI)
  9. W-9

All of this information is to be uploaded to CAQH Proview. ( https://proview.caqh.org/pr).  Please contact Davis Vision if you need assistance with CAQH Proview.