How to participate in PathfinderHealth

Thank you for your interest in participating in PathfinderHealth, LLC, or PFH. Clinicians and other health care provider organizations participating in PFH agree to be accountable to one another for the quality, cost and overall care of patients covered under PFH’s value-based agreements with health care payers. This includes a focus on evidence-based medicine, patient-centered care and following clinical guidelines, quality assurance and improvement programs, and performance-based metrics as directed by PFH’s physician-led board of managers.

Getting started

Clinicians interested in participating in PFH should email [email protected] to learn about the application process.

Network committee review

Clinicians must be approved by the members of PFH’s board of managers with the advice and recommendation of the network committee and sign a standard Participation Agreement to participate in PFH, a copy of the participation agreement is available for review upon request. The network committee meets monthly on the fourth Wednesday of each month. Complete applications received by the second Friday of each month are typically reviewed at the committee’s meeting that same month.

Participation criteria

The network committee considers a variety of factors when reviewing clinicians for participation, including the following requirements and expectations:

  • Unrestricted license to practice in Arizona
  • Mid-levels supervised by a licensed physician of the same specialty
  • Eligible to participate in Federal health care programs
  • Board Certified or Board Eligible (as defined by ABMS Member Boards)
  • Currently credentialed and contracted with one or more PFH payer partners
  • Reputation within the community; professional medical practice relationships with other PFH providers
  • Operational EMR
  • Commitment to coordinate care within PFH’s network of participating providers/facilities

Application denial appeal option

Clinicians and other health care provider organizations who are not approved to participate in PFH are eligible to re-apply 12-months from the date the application was declined. Applicants also have the option to appeal the decision of the board of managers, as outlined below:

  • Within 30 days following the date of denial notice, the provider must notify PFH by email ([email protected]) of the intent to appeal*
  • Provider may file a written appeal for initial consideration by the network committee, which should include information the network committee will take into consideration when evaluating the appeal.  Additionally, in the written appeal, the provider may request the opportunity to present directly to the network committee during a 15-minute slot at an upcoming committee meeting, as scheduled.
  • The network committee will deliberate on the appeal and formally arrive upon a recommended action for consideration at the next monthly board of managers’ meeting (recommendations to either approve the application -or- reaffirm the declined application require the board of managers’ approval).
  • The board of managers’ decision on the appeal will be final.
  • If the application denial is upheld by the board of managers, the provider will remain eligible to re-apply 12 months following the original application denial.

*Currently there are limited appeal options for certain denials, including concerns with the provider’s state license, federal program exclusions, and/or lack of Board Certification/Board Eligibility.