Credentialing

Last updated: Aug 6, 2026 · Nexus Medical Network LLC · Applies to all providers applying to join or currently participating in the Nexus network

Overview

Nexus Medical Network LLC ("Nexus") credentials every provider and practice before they are permitted to receive personal injury referrals through the Nexus platform. Credentialing is the process by which Nexus verifies that a provider holds the active licensure, professional insurance, and professional standing required to participate in the network.

Credentialing is a condition of participation in the Nexus network and is incorporated into the Administrative Services Agreement executed between Nexus and each participating provider practice. A provider may not receive referrals through Nexus until credentialing is complete and the Administrative Services Agreement — including the Business Associate Agreement (Exhibit D) — has been fully executed.

Why credentialing matters

Personal injury cases have specific medical-legal requirements that standard clinical practice does not always address. Medical records and professional opinions generated in connection with a personal injury case may be reviewed, challenged, or used as evidence in legal proceedings. Records from unlicensed or unverified providers risk exclusion and can undermine the legal value of treatment.

Credentialing protects three distinct interests:

Patients— Every patient referred through Nexus is treated by a provider whose credentials have been independently verified, not assumed.

Attorneys— Referring attorneys can submit cases with confidence that every Nexus provider has passed a credentialing review, reducing the due diligence burden on law firm staff.

Providers— Network participation signals that a practice meets the professional standards required for PI-related treatment and documentation.

Accepted specialties

Nexus credentials providers across the specialties most commonly required in personal injury cases across Pennsylvania, New Jersey, and New York. Accepted specialties include:

Chiropractic— Licensed Doctor of Chiropractic (DC) with active, unrestricted licensure in the applicable state(s).
Physical Therapy— Licensed Physical Therapist (PT) or Physical Therapist Assistant (PTA) with active licensure and PI documentation experience preferred.
Pain Management— Board-certified physician or Doctor of Osteopathic Medicine (DO) with active DEA registration where applicable.
Orthopedic Surgery— Board-certified or board-eligible orthopedic surgeon with spine and/or extremity sub-specialization.
Neurosurgery— Board-certified neurosurgeon with active hospital privileges.
Imaging / Radiology— Accredited MRI and imaging facility with board-certified radiologist for reads.
Urgent Care— State-licensed urgent care facility with established capability for PI intake documentation and injury evaluation.
Other specialties— Reviewed on a case-by-case basis. Contact Nexus to discuss eligibility before submitting an application.

Credentialing requirements

All providers applying to join or currently participating in the Nexus network must meet and maintain the following requirements:

Active, unrestricted license.All treating providers must hold a current, active, and unrestricted professional license in the state(s) in which they practice — PA, NJ, and/or NY. Licenses must be renewed before expiration and current at all times.
No undisclosed disciplinary actions.Providers must disclose any pending or past disciplinary actions, license suspensions, sanctions, or exclusions by a state licensing board, the OIG, or any federal or state agency. Undisclosed actions discovered after onboarding are grounds for immediate removal.
Current malpractice insurance.All providers must maintain active professional liability (malpractice) insurance at coverage levels appropriate for their specialty and state of practice. Proof of coverage in force must be provided at credentialing and kept current throughout participation.
Executed Administrative Services Agreement.Participation in the Nexus network requires full execution of the Nexus Administrative Services Agreement, including the Business Associate Agreement (Exhibit D), prior to receiving any referral through the platform.
PI documentation capability.Providers must be capable of generating the documentation required for personal injury cases — including initial evaluations, progress notes, and narrative reports — in a complete, timely, and legally defensible format suitable for use in litigation or settlement.
Compliance with applicable law.Providers must comply with all applicable federal and state healthcare laws, including HIPAA, the Anti-Kickback Statute, the Stark Law, and all applicable state licensure and corporate practice of medicine requirements.

Required documents

The following documents must be submitted as part of the credentialing application. Nexus reviews all submissions and reserves the right to request additional materials or clarification before approving network participation.

Copy of current professional license(s) for all states of practice
DEA registration certificate, where applicable
Proof of malpractice insurance — declarations page showing coverage type, limits, and policy period
Curriculum vitae or professional biography for each treating provider
W-9 form for the practice or provider entity
Individual and group NPI numbers
Practice or facility address, hours of operation, and contact information
Board certification documentation, where applicable
Hospital privilege documentation, where applicable
Written disclosure of any disciplinary history, including resolved matters

The credentialing process

The credentialing process proceeds as follows after submission of a completed application and all required documents:

Application review. Nexus reviews the application for completeness and confirms that all required documents have been received. Incomplete applications are returned with a request for the missing materials.
License verification. Nexus verifies the provider's license status directly through the applicable state licensing board. A license that is suspended, restricted, or not in good standing will result in application denial.
Insurance confirmation. Malpractice coverage is verified as current, active, and at appropriate limits for the provider's specialty and state.
Disciplinary review. Nexus reviews disclosed disciplinary history and may independently verify sanctions, exclusions, or adverse actions through available public records.
Agreement execution. Upon successful credentialing review, the Administrative Services Agreement — including the Business Associate Agreement — is sent for electronic execution via DocuSign.
Onboarding and portal access. Upon execution of the agreement, the practice is onboarded to the Nexus Platform, portal credentials are issued, and a platform walkthrough is completed with a Nexus coordinator.

Most applications are completed within 5–10 business days of receiving all required documents, assuming no deficiencies or questions arise during the review.

Ongoing obligations

Credentialing is a continuing condition of network participation, not a one-time review. Provider practices are required to:

Notify Nexus immediately of any change in licensure status — including renewals, restrictions, suspensions, or revocations — for any individual treating provider within the practice.
Notify Nexus immediately of any change in malpractice insurance coverage, including policy lapses, coverage reductions, or carrier changes.
Notify Nexus promptly of any disciplinary action, investigation, OIG exclusion, or sanction initiated against any treating provider in the practice.
Notify Nexus of any material change in practice ownership, structure, or location that may affect the terms of the Administrative Services Agreement.
Ensure that any new individual provider added to the practice who will treat Nexus-referred patients completes credentialing review before treating any such patient.

Failure to provide timely notice of a material change in the above categories is grounds for suspension or removal from the Nexus network, in addition to any remedies available under the Administrative Services Agreement.

Recredentialing

Nexus conducts periodic recredentialing reviews of all active network providers. The recredentialing cycle and specific review criteria are determined by Nexus at its discretion, based on the nature of the specialty, volume of referrals, and any intervening events that may affect the provider's standing.

At recredentialing, providers will be required to provide updated documentation, including current licensure, current malpractice coverage, and a refreshed disclosure of any disciplinary history since the prior review. Providers who do not respond to recredentialing requests within the required timeframe may be suspended from receiving new referrals until the review is complete.

Removal from the network

Nexus reserves the right to suspend or remove any provider from the network at any time if:

A provider's license is suspended, restricted, or revoked by any applicable state licensing board.
A provider is excluded from participation in federal or state healthcare programs.
A provider's malpractice coverage lapses or is materially reduced below required levels.
A provider fails to disclose a material disciplinary action, sanction, or change in professional standing.
A provider materially breaches the Administrative Services Agreement and fails to cure the breach within the timeframe specified in that agreement.
Nexus determines, based on its own review or on legal counsel's advice, that continued participation would expose Nexus, attorneys, or patients to legal, regulatory, or reputational risk.

Where possible, Nexus will provide notice and an opportunity to cure before removing a provider from the network. Removal does not affect Nexus's rights and remedies under the Administrative Services Agreement.