Provider Definitions

The information on the CalOptima Provider Search tool is self-reported at the time of initial credentialing and at least every three years thereafter at the time of recredentialing by the listed provider, except Board Certification, which CalOpitma does confirm. All information in the physician and hospital directory is updated within one week of receipt of the accurate and confirmed information.

	Provider Definition	Information Collection and Validation
Name	N/A	Information is self-reported and updated at least annually by the provider. Changes may occur between validation time frames.
Gender	N/A	Information is self-reported and updated at least annually by the provider. Changes may occur between validation time frames.
Office Location	N/A	Information is self-reported and updated at least annually by the provider. Changes may occur between validation time frames.
Phone Number	N/A	Information is self-reported and updated at least annually by the provider. Changes may occur between validation time frames.
Specialty	The clinical area in which the CalOptima contracted physician practices	Information is self-reported and updated at least annually by the provider. Changes may occur between validation time frames.
Hospital Affiliations	A listing of the network hospitals where the provider cares for patients	Information is self-reported and updated at least annually by the provider. Changes may occur between validation time frames.
Medical Group	A group of doctors who have a business together and contract with a health plan to provide services to the plan's members	Information is self-reported and updated at least annually by the provider. Changes may occur between validation time frames.
Medical Group Affiliations	A practitioner/doctor who has an association with a specific medical group or groups	Information is self-reported and updated every three years during re-credentialing. Changes may occur between validation time frames.
Board Certifcation	When a health care practitioner is board certified, it means that he/she has applied for and been awarded certification from the American Board of Medical Specialties (ABMS), American Osteopathic Association, or other recognized board. Board certification is a voluntary process. To become board certified, a physician must: Graduate from an accredited professional school Complete a specific type and length of training in a specialty Practice for a specified amount of time in that specialty Pass an examination given by the professional specialty board For more information about your physician’s board certification, visit the ABMS website at www.abms.org.	Information is self-reported and updated every three years during re-credentialing. Changes may occur between validation time frames.
Acceptance of new members	Indicates whether the provider is accepting new patients in his/her practice	Information is self-reported and updated at least annually by the provider. Changes may occur between validation time frames.
Languages	The languages other than English that the provider or clinical staff speaks and understands.	Information is self-reported and updated every three years during re-credentialing. Changes may occur between validation time frames.
Physical Accessibility	Refers to a site, facility, work environment, service, or program that is easy to approach, enter, operate, participate in, and/or use safely and with dignity by a person with a disability.	Upon completion of a provider facility site review, by using the data obtained through Attachment C of the FSR tool to determine and identify physical accessibility indicators.
Medical Group Affiliations	A group of contracted physicians that provides health care services to CalOptima Members.	Information is self-reported and updated every three years during re-credentialing. Changes may occur between validation time frames.
Health Network	A group of doctors and hospitals that provides health care services and has a contract with CalOptima.	Information is self-reported and updated every three years during re-credentialing. Changes may occur between validation time frames.