The qualifications of doctors and other providers in our PPO and HMO networks are reviewed before they can be in our network and every three years thereafter. The items reviewed include:

• Qualifications to practice in a specialty
• Actions of licensing boards
• Actions of medical staff committees
• Quality of care issues
• Member complaints
• Malpractice cases
• Claims data
• Medicare/Medicaid sanctions
• Information from the National Practitioner Data Bank and the Healthcare Integrity Protection Data Bank

The qualifications of hospitals in our PPO and HMO networks are reviewed before they can be in our network and on a regular basis thereafter. The items reviewed include:

• Medicare Certification and Program Participation
• Liability insurance verification
• Joint Commission Certification verification (if applicable)
• Texas Department of Public Health License verification
• Actions of licensing boards