For Providers: What Do I Need to Know About Credentialing and Recredentialing?

Credentialing is a verification process that proves you have the appropriate license, education, insurance and other qualifications necessary for your provider type.

It's also part of the process of joining our network and enrolling as a new provider. The first thing you’ll do is fill out an enrollment form. Then we verify that the information submitted is accurate. 

Our online provider enrollment is split into two sections: one for hospitals and facilities and one for physicians and professionals, also called practitioners. Here’s what you need to know about credentialing for each section.

For hospitals, facilities and allied providers

We handle the credentialing process for hospitals, facilities and allied providers. You’ll just need to fill out the appropriate enrollment form based on your facility type. Then make sure you review the required document checklist and provide all the necessary documentation along with any signature documents. 

The checklist and signature documents are available online from within provider enrollment. When credentialing is complete, we’ll notify you of your status.

Recredentialing for hospitals, facilities
and allied providers

Hospitals, facilities and allied providers are required to recredential every three years from the time they first join our network. Required forms need to include a signature and must be dated within 120 days of the request.

Use this form: Credentialing and Recredentialing Facility and Allied
Provider Form (PDF)

For physicians and professionals

We use the CAQH Provider Data Portal to gather and coordinate the information needed for credentialing. Developed by the Council for Affordable Quality Healthcare^®, the CAQH Provider Data Portal simplifies provider data collection by allowing providers to enter, submit, and store all data electronically.

In addition to filling out our enrollment form, you’ll need to create a profile on the CAQH Provider Data Portal. We can’t complete credentialing without it.

Tips regarding enrollment

• Attestation must be completed within 14 days of submitting your enrollment form.
• New graduates can submit an enrollment form to us up to 60 days before finishing training.
• If you’re relocating from out of state, you can submit your enrollment form 30 days before your start date.

Tips regarding the CAQH Provider Data Portal

• Complete your CAQH Provider Data Portal application within 14 days after submitting your enrollment form.
• Make sure your attestation is up to date if you already have a CAQH Provider Data Portal profile.
• Be careful when choosing your primary specialty in the CAQH Provider Data Portal because your choice determines whether you’re designated as a PCP or specialist for managed care networks, may affect the way your claims are processed and will appear in our online provider directories.

Recredentialing for physicians and professionals

We use the CAQH Provider Data Portal to support your credentialing process. You must complete all application questions, authorize us to access your credentialing information, and attest to your data profile. Recredentialing is required every three years.

How can I check credentialing status?

Call us at 1-800-822-2761. Have these things handy for each provider listed on the enrollment form:

• NPI
• Group tax ID number or the last four digits of each provider's Social Security number
• The provider's primary address and phone number