Policies and Procedures

Credentialing and Recredentialing

The Credentialing Program outlines the standards, processes, and policies used to evaluate a licensed practitioner’s credentials, qualifications, and other criteria whether the practitioner should be approved to provide health care services to Embright members. It may be changed at the discretion of the Credentialing Committee.

Network Policies

The network policies demonstrate that Embright has the processes and procedures to effectively manage access to care and member experience.

Provider Participation Criteria

Embright has a number of requirements for network participation that support quality of care and service as well as a supportive working relationship with our network partners. Review Working with Embright to review the benefits of joining the Embright network.

Out-of-Network Care

There may be rare situations where you think that a member may need care outside of the Embright network. In these rare situations, you will need to go through a waiver referral process to request out-of-network care at an in-network rate. The waiver referral process is limited to approving care services outside of the Embright network and does not guarantee that the services will be covered by the member’s health plan.