Provider Verification Process

When a provider joins or leaves a PMG, the PMG must notify us. They’re also responsible for providing accurate and up-to-date information about their providers, including name, address, phone number and gender.

This field shows whether a provider is currently accepting new patients. The PMG must notify SHP when a provider starts or stops accepting new patients.

Physicians earn board certification in a medical specialty through the American Board of Medical Specialties (ABMS) or the American Osteopathic Association (AOA). PMGs verify these certifications during credentialing and re-credentialing and share the information with us. 

To check a physician’s current board certification status, visit ABMS Certification Matters. For a Doctor of Osteopathic Medicine, you can confirm their certification by calling the AOA Member Service Center at 800 621-1773 and selecting option 1.

This field shows the Sutter hospitals where doctors can treat or admit patients. PMGs verify hospital affiliation information during the credentialing and re-credentialing process and report it to us, including any updates or changes to a physician’s affiliations.

This field identifies which PMG a provider is associated with. When a provider joins or leaves a Sutter Health Plan PMG, the PMG must notify us.

This field shows the languages other than English that the physician speaks and understands. Physicians self-report this information to their affiliated PMG when they’re credentialed and re-credentialed. Then, the PMGs report this information to us.

A specialty is a specific area of medicine that a provider focuses on. It could be related to a body system, an age group or a unique technique for diagnosing or treating certain conditions. A specialist may or may not be board certified. Our PMGs verify specialty information during the credentialing and re-credentialing process and report any changes to us.

We verify information from PMGs to confirm that each hospital meets state and federal requirements and holds proper accreditation from the appropriate organization. We verify hospitals when they join Sutter Health (credentialing) and every 36 months afterward (re-credentialing).

Accreditation means a hospital has been evaluated and met specific quality and safety standards set by an accrediting body, such as The Joint Commission (TJC). We also annually review and verify the hospital’s name, location and accreditation status.