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4. Physicians credentialed for participation with Bravo Health that are not board certified must have
completed an approved residency training program with the following exception noted below.
If not board certified, the credentialing staff will verify the physician’s residency. Residencies will
be verified through the AMA or AOA physician master profile for the specialty being requested or
by writing the residency program itself. For podiatrists, the residency will be verified by writing the
residency program itself. Board certification and residency verifications are completed within 180
days of being presented to the PACC.
Exception: If a physician is not board certified but has completed internship/residency training
prior to January 1, 1980 AND has ten year’s of experience in his/her trained specialty, then the
physician may be credentialed and listed in that designated specialty and is considered to be
“grandfathered.”
5. For physician listings in Bravo Health provider directories:
• Upon initial credentialing, if a physician is board certified in his/her primary specialty and has
the appropriate fellowship training or board certification in his/her subspecialty, then the
physician may be credentialed and listed in both the primary specialty and the subspecialty.
• Upon initial credentialing, if a physician is not board certified in his/her primary specialty, then
he/she may not be listed in his/her subspecialty. The physician will be credentialed and listed
only in his/her primary specialty for which he/she has the appropriate residency training as
outlined in # 4 above.
If the physician’s designated specialty includes the provision of services in a hospital setting, then:
a. The physician must demonstrate active privileges at a state licensed acute-care hospital that is
currently contracted with Bravo Health or part of the evolving network; or
b. The physician must provide to Bravo Health a written explanation as to why he/she does not have
hospital privileges and an acceptable method of hospitalizing Members. Both the applicant and the
Bravo Health contracted admitting physician must submit documentation of the arrangement; and
c. If the physician does not have hospital privileges due to any reason other than a strictly voluntary
relinquishment by the physician, the physician’s application will be reviewed by a Bravo Health Medical
Director and forwarded for review to the PACC.
6. Primary care physicians must have coverage arrangements with a Bravo Health Participating
physician to assure that services are available on a twenty-four-hour-a-day, seven-days-a-week basis.
7. Practitioners must disclose for Bravo Health Credentialing Committee review all claims or suits
alleging malpractice that have been filed against him or her or appealed or settled by the physician or
his or her insurance carrier in the past five (5) years.
8. Practitioners who currently or have ever been excluded from Medicare and/or Medicaid participation
is not eligible for participation with Bravo Health. If a physician is accepted into Bravo Health and
then is excluded from Medicare and/or Medicaid participation, that physician will be terminated.
