What do I need to know about credentialing?

Who is this for?

Learn about what's involved in credentialing for new providers.

If you want to join our network, credentialing is part of the process. This will help give you an overview of what that involves.

To join our network 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. Depending on the type of provider you are, we want to know you have the appropriate license, education, insurance and other qualifications. That verification process is called credentialing.

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 and facilities

We handle the credentialing process for hospitals and facilities. 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.

For physicians and professionals

We use the Council for Affordable Quality Healthcare®, or CAQH, to gather and coordinate the information needed for credentialing. In addition to filling out our enrollment form, you’ll need to create a profile on CAQH ProView™. We can’t complete credentialing without it.

Keep these tips in mind when you're filling out our enrollment form and using CAQH ProView.

  • After you’ve submitted your enrollment form to us, you need to complete your CAQH ProView  application within 14 calendar days.
  • Already have a CAQH ProView profile? Make sure your attestation is up to date. Attestation must be completed within 14 calendar days of submitting your enrollment form to us.
  • New graduates can submit a an enrollment form to us up to 60 days before you finish training.
  • If you’re relocating from out of state, you can submit your enrollment form to us 30 days before your start date.

More helpful information about CAQH ProView

Choosing your primary specialty

Be careful when choosing your primary specialty in CAQH ProView because your choice:

  • Determines whether you’re designated as a primary care physician or specialist for managed care networks
  • May affect the way claims are processed and paid
  • Will be shown in our online provider directories

Malpractice insurance information

CAQH will need your current malpractice insurance fact sheet. Ask your malpractice insurance carrier to submit your liability insurance information on time. Send the Professional Liability Verification Form (PDF) and the Authorization for Release of Information Form (PDF) to your current insurance carriers. Please note that the Professional Liability Verification form needs to be completed by your carrier and faxed to the number on the form.

Want to know more about CAQH ProView?

Visit CAQH.org, call 1-888-599-1771 or you can read our CAQH FAQ (PDF).

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

What about recredentialing?

All providers need to periodically review and update the information they used to credential. This process is called recredentialing. How do I recredential? has the forms and information you need.

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