Provider affiliation
A provider affiliation is a link between a clinician and an organization, such as the medical group they work for, the hospitals where they have privileges, or the networks they belong to. Affiliations change often and are a common source of directory errors.
Which affiliations matter?
Group affiliation (who the clinician practices with and bills through), hospital affiliation (where they can admit and treat patients) and network affiliation (which plans and products they participate in).
Why do affiliations go stale?
Clinicians change groups, groups merge, and hospital privileges lapse, often without the change reaching every plan's records.
Why does it matter?
Affiliations drive referrals, network status and where a provider appears in the directory. Medicaid managed care rules, for example, require directories to show group affiliation.