Provider information

Fallon Health Weinberg-HMO SNP follows national rules when we choose our doctors and check their information. Aperture Credentialing, Inc., is a company we work with to do this. This chart shows the information we check about a doctor. In the chart, a doctor is called a "practitioner."

Topic Explanation Source Frequency of Validation Limitations

Acceptance of new patients

Is the practitioner taking new patients?

Practitioner/office staff

Self-reported/not validated

Fallon Health Weinberg-HMO SNP may not be notified if this status changes.

Gender

Is the practitioner male or female?

Credentialing application

Self-reported/not validated

Not all practitioners provide this information since it is optional.

Hospital affiliations

The hospital or hospitals where practitioner has admitting privileges

Credentialing/recredentialing application

Verified directly with primary hospital at the time of credentialing 
and/or recredentialing (at least once every three years)

When practitioners change sites, their hospital affiliations may not be updated until the time of their next recredentialing (at least once every three years).

Languages spoken by practitioner

The languages the practitioner speaks with sufficient fluency to treat patients who speak only that language

Credentialing/recredentialing application

Self-reported/not validated

Not all practitioners provide this information since it is optional.

Board certification

Indicates whether or not the practitioner has completed a training program in a specialty and has passed an exam to assess his or her knowledge, skills, and experience to provide quality patient care in that specialty

Credentialing/recredentialing application

Verified directly with each board at the time of credentialing and/or recredentialing (at least once every three years)

Fallon Health Weinberg-HMO SNP may not always be notified when a practitioner receives a new board certification. This information will be updated at the time of the next recredentialing (at least once every three years).

Medical group affiliations

The medical group or groups that the practitioner is employed by or otherwise associated with

Credentialing/recredentialing application

Verified at credentialing 
and/or recredentialing (at least once every three years)

Verified when change form is received

Fallon Health Weinberg-HMO SNP may not always be notified when a practitioner changes medical group affiliations.

Specialty

The specialty or sub-specialty area in which the practitioner provides care

Credentialing/recredentialing application
Change forms submitted by office/practitioner
Information received from specialty boards

Verified at credentialing 
and/or recredentialing (at least once every three years)

Verified when change form is received

 

 

Fallon Health Weinberg is an HMO plan with a Medicare contract and a coordination of benefits agreement with the New York State Department of Health. Enrollment in Fallon Health Weinberg depends on contract renewal.

H2470_W_2017_7 Approved 10182016
The information on this page was last updated on 10/1/2017.

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Contact us

Information before enrolling:
1-855-561-7248 (TTY 711)
8 a.m.–8 p.m., Monday–Friday
(Oct. 1–Feb. 14, seven days a week)

Customer Service:
1-855-561-7247 (TTY 711)
8 a.m.–8 p.m., Monday–Friday
(Oct. 1–Feb. 14, seven days a week)