What credentialed, paneled, in-network, and contracted mean

Check what you learned

10 questions from this lesson. Answers are checked as you go; nothing is recorded.

1. 1 / 10

   What does the term "credentialed" specifically refer to according to the lesson?

   AA provider has completed a background check and received committee approvalBA provider has signed a participation agreementCA provider has been enrolled in a payer’s systemDA provider is listed on the payer’s directory
   Hint

   Look at the definition of credentialing in the lesson.

2. 2 / 10

   Which step comes immediately after credentialing in the process described?

   AContractingBRecredentialingCEnrollingDPaneled
   Hint

   The lesson lists the order of steps.

3. 3 / 10

   What is required for a provider to be considered "in-network"?

   AThey must be enrolledBThey must be credentialedCThey must have a signed contract with the insurerDThey must be listed on the insurer’s directory
   Hint

   Check the definition of in‑network in the lesson.

4. 4 / 10

   Which of the following is NOT a proof that a provider is "paneled"?

   AThe provider’s name in the plan’s directory verified every 90 daysBA signed participation agreementCName in the plan’s provider directoryDA written notice of credentialing completion
   Hint

   Paneled is trade slang for contracted and listed.

5. 5 / 10

   According to the lesson, what does the term "enrolled" specifically indicate for Medicare and Oregon Health Plan?

   AThe provider’s information is loaded into the payer’s claims systemBThe provider is listed on the directoryCThe provider has been credentialedDThe provider has signed a contract
   Hint

   Enrolled is used for Medicare and OHP with distinct forms.

6. 6 / 10

   Which clause in Oregon law sets the maximum time a payer has to decide on a credentialing application?

   AOAR 836-053-0350BORS 743B.454COAR 410-141-3510DORS 743B.280
   Hint

   The lesson mentions a 90‑day period.

7. 7 / 10

   What does the lesson say about the relationship between recredentialing and a provider’s contract?

   ARecredentialing ends the contractBRecredentialing renews the contractCRecredentialing is required before contractingDRecredentialing does not affect the contract
   Hint

   Look at the paragraph about recredentialing clocks.

8. 8 / 10

   Which of the following is a requirement for a provider to be considered "out-of-network"?

   ABeing credentialed by the insurerBBeing listed on the insurer’s directoryCHaving a signed contract with the insurerDNone of the above
   Hint

   Out-of-network is the default state.

9. 9 / 10

   What does the lesson identify as the primary purpose of the "paneled" status?

   ATo confirm the provider is on the payer’s provider listBTo prove the provider has a contract with the insurerCTo show the provider is enrolled in the payer’s systemDTo indicate the provider has been credentialed
   Hint

   Paneled is trade slang for contracted and listed.

10. 10 / 10

    Which of the following is NOT a proof that a provider is "contracted"?

    AThe provider’s name in the plan’s directoryBThe signed network participation agreement with terms and ratesCThe countersigned participation agreementDThe written notice that credentialing is complete
    Hint

    Contracted is proven by the agreement, not the directory.