MA Provider Selection

Now, let’s look at how an MA Plan selects providers. As we just discussed, most MA Plans have provider networks that plan members must use for health care services. Providers of MA services must have an agreement with CMS allowing them to offer services under Original Medicare.

MA organizations have written policies and procedures when selecting and evaluating health care professionals to include in an MA Plan’s provider network. Certain health care professionals must undergo credentialing to join a provider network.