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All practitioners in Pennsylvania have the option of completing the PA Standard Application or submitting a printed version of the pre-populated CAQH application to Gateway for review and consideration. The CAQH application is mandatory in Ohio.

Gateway is committed to protecting the confidentiality of all provider information obtained by the Credentialing Department and to conducting credentialing/recredentialing in a non-discriminatory manner.

Gateway standards require that all practitioners hold applicable staff/clinical privileges in their practicing specialty at a Gateway participating hospital. Primary care practitioners without staff/clinical privileges must have written documentation of a formal coverage arrangement with another Gateway participating practitioner who hold active privileges at a Gateway participating hospital.

Practitioners who are called to active Military Duty may remain participating through an established Gateway process. It is the responsibility of the practitioner or his/her office to notify Gateway in writing that the practitioner has been called to active duty, when the practitioner will be leaving and an approximate date of return. The letter should also include information regarding the practitioner who will be covering during the military leave. The Gateway Credentialing Department will not terminate the practitioner if he/she is called to active duty and have a formal coverage arrangement. The practitioner’s office should notify Gateway of the practitioner’s return, as soon as possible, but not to exceed 14 days from the practitioner’s return to the office. The Gateway Credentialing Department will determine, based upon the length of time the practitioner was on active duty, if the practitioner must complete a recredentialing application.

Gateway’s Credentialing Department conducts ongoing monitoring of providers to include, but not limited to: Medicare/Medicaid sanctions, licensure sanctions, disciplinary actions and member complaints. The ongoing monitoring allows Gateway to identify and act on pertinent member quality and safety issues. All information that is gathered during the ongoing monitoring process is made available for review and consideration by the Quality Improvement and Utilization Management Committee. Gateway affords practitioners a due process procedure for quality of care terminations.

Gateway providers have the right, upon request, to be informed of the status of their credentialing/recredentialing applications.

Gateway will notify providers of their right to review and correct erroneous information in the event that information varies substantially from the information submitted by the practitioner.

Providers are notified in writing by Gateway’s Credentialing Department of all credentialing/recredentialing decisions within 10 business days of the Quality Improvement and Utilization Management Committee’s decision.

In accordance with Gateway’s business practices, the inclusion of a provider in Gateway’s provider network is within the sole discretion of Gateway.