Provider Term Glossary

Accepting New Patients: This healthcare provider accepts both new and existing patients. We collect this information when they join the network. The provider is required to request this be changed if their group practice situation dictates a closure in practice. We rely on the provider to keep us informed of their status and this information is not verified independently.
 
Accreditation: A review process that hospitals and other health care facilities voluntarily participate in to improve the safety and quality of the care and services they provide. Information is collected at the time the facility initially joins the network and then every 3 years thereafter. Verification is obtained either by contacting the accrediting agency directly or by obtaining a copy of the approval letter or report provided by the facility. Facilities may also notify us at any time regarding changes to their accreditation status.
 
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. This information is collected from the provider at the time they initially join the network and then every 3 years thereafter or it is updated if the provider contacts Prevea360 Health Plan about a change
 
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: 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. This information is supplied by the provider at the time of initial credentialing and collected every 3 years thereafter.
 
Specialty: The specific area of medicine in which a provider has been trained. Specialty information is collected at the time the provider joins the network and verified every three years thereafter.