Provider term glossary

Board certification: There are two applicable statuses, board certified and board eligible as defined below.

• Board certified:  A provider who is certified has
  • Received training from an approved residency program
  • Voluntarily taken and passed a comprehensive test of his or her knowledge in a specialty
  • Met the other requirements set by the board that gives the test.
• Board eligible: a provider who is eligible has:
  • Completed an approved residency and/or fellowship
  • Qualified to take a comprehensive test to become board-certified, but has not taken the test.

We collect board certification information when a provider joins the network and every 3 years thereafter. In each instances, this information is verified with a primary source.

The most current board certification status can be viewed at the American Board of Medical Specialties (ABMS) website, www.abms.org. The service is free, but you will have to register and log into the site.
Board certifications for most Doctors of Osteopathic Medicine (D.O.) free at www.osteopathic.org.

Facility: The name of a hospital, care center, or other health care site as provided to us by the health care entity.

Gender: Information stating whether a person is male or female is provided by health care providers when they initially join our network.

Hospital affiliation: The name of a hospital with whom a provider has admission privileges or is able to send patients to that facility for care. 

Hospital quality data:

• wicheckpoint.org: CheckPoint delivers reliable reports designed to make health care decisions and assist Wisconsin hospitals with quality improvement activities.
• medicare.gov/hospitalcompare: Compare hospitals based on their overall star rating, summarizing up to 64 measures of quality shown on Hospital Compare. 

Office and phone number: The address of the site where a provider practices. This information is not verified by Prevea360 Health Plan.

Practice group: A group of providers who practice together at the same location(s).

Practice name: The name used by a provider or group of providers. Providers give us their practice names when they join our network and it is verified every three years thereafter or it is updated if the provider contacts Prevea360 Health Plan about a change.

Professional degrees

ACSW: Academy of Certified Social Workers - A certified social worker meeting specific requirements in supervised social work experience and reference ratings. Also has passed the ACSW written examination. Note: Not all eligible social workers voluntarily achieve this designation.

CNM: Certified Nurse Midwife - A registered nurse who has received additional training as a midwife, delivers infants, and provides antepartum and postpartum care.

CSW: Certified Social Worker - An individual registered as a Certified Social Worker with the State of Wisconsin.

DC: Doctor of Chiropractic - a specialist licensed in a system of therapy which holds that disease results from a lack of normal nerve function and which employs manipulation and specific adjustment of body structures (as the spinal column).

DDS: Doctor of Dental Surgery - A specialist licensed in dentistry.

DMD: Doctor of Dental Medicine - A specialist licensed in dentistry.

DO: Doctor of Osteopathic Medicine - The degree a person receives after completing four years of medical school. A doctor of osteopathic medicine is licensed in the system of medical practice based on a theory that diseases are due chiefly to loss of structural integrity, which can be restored by manipulation of the parts supplemented by therapeutic measures (as in the use of medicine or surgery). After completion of medical school, a doctor of osteopathic medicine chooses an area of medicine to specialize in a Residency.

DPM: Doctor of Podiatric Medicine - A specialist licensed in the medical care and treatment of the human foot.

Ed.D.: Doctor of Education - The degree a person receives after completing a four-year post-graduate program specific to their field. For example, psychology.

LLP: Limited Licensed Psychologist - An individual issued a limited license by the State of Wisconsin to practice psychology. A person with this license practices under the supervision of a licensed psychologist.

LCSW: Licensed Clinical Social Worker - The degree and license a person receives after completing a graduate-level program in social work.

LPC: Licensed Professional Counselor - An individual issued a license by the State of Wisconsin Department of Regulation and Licensing to practice counseling.

MA: Master of Arts - The degree a person receives after completing a graduate-level program specific to their field.

MD: Medical Doctor - The degree a person receives after completing four years of medical school. A medical doctor is licensed in the science and art of dealing with the maintenance of health and the prevention, alleviation, or cure of disease. After completion of medical school, a medical doctor chooses an area of medicine to specialize in and completes a Residency.

MS: Master of Science - The degree a person receives after completing a graduate-level program specific to their field.

NP: Nurse Practitioner - A registered nurse who through advanced training is qualified to assume some of the duties and responsibilities formerly assumed only by a physician.

OD: Doctor of Optometry - A specialist licensed to practice the art or profession of examining the eye for defects and faults of refraction and prescribing especially corrective lenses or exercises.

PA, PA-C: Physician Assistant, Physician Assistant - Certified - A specially trained person who is certified to provide basic medical services (as the diagnosis and treatment of common ailments) usually under the supervision of a licensed physician.

Ph.D.: Doctor of Philosophy - The degree a person receives after completing a four-year post-graduate program specific to their field. For example, clinical psychology.

Psy.D.: Doctor of Psychology - The degree a person receives after completing a four- year post-graduate program in psychology.

Residency: A period of advanced medical training and education that typically follows medical school graduation and licensing. Residency consists of supervised practice of a specialty in a hospital outpatient department and includes instruction from specialists on the hospital staff.

Language: Primary and secondary languages spoken by a provider. English is listed for all network providers and any secondary languages are also noted.

Specialty: The specific area of medicine in which a provider has been trained.

How we choose network physicians, providers & hospitals

Quality of care

Before providers join our networks, we check to see that they have the appropriate education, licensure, and training to provide quality care.

While Prevea360 Health Plan does not use specific quality, member satisfaction, cost-related or patient safety measures for selecting providers and hospitals to participate in our networks, we require that all providers meet our stringent credentialing standards, which include the verification of licensure, education, training, and malpractice and sanction history prior to joining our network. Ongoing quality monitoring of physicians and providers is accomplished by checking for licensure and other sanctions, and investigating, tracking, and trending member complaints about quality of care.

Location

Easy and prompt access to the care you need from wherever you are is important. That's why we work hard to include network providers in the areas we serve so that you can get the care you need from local doctors, hospitals and other health care professionals.

To ensure you can find the care you need, we consider the following:

• How far you have to travel to see a provider
• The number of available providers in your area
• The number of primary care physicians in your area accepting new patients
• The languages the providers speak
• How long it takes to make an appointment and see a provider
• How easily you can access routine, urgent and emergency care

We strive to ensure that all members have access to a physician or other health care professional within 30 minutes driving time or 30 miles from your home. If we are unable to achieve that we will work with you to find the nearest network provider to meet your needs.

Types of providers

To best meet your health care needs, our networks include a wide range of health care providers, including:

• Primary care physicians, including family medicine, internal medicine, and pediatricians
• Specialists such as general surgeons, dermatologists and cardiologists
• Skilled nursing facilities and rehabilitation hospitals
• Acute care hospitals
• Behavioral health providers, including psychiatrists and therapists
• Diagnostic imaging centers

If you have questions about our networks, call Prevea360 Health Plan Customer Care Center at 877-230-7555.