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.
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.
Hospitals and facilities 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.
If you're a:
Use this form: Allied Provider Recredentialing Form (PDF)
All other facilities should use the Facility Provider Recredentialing Form (PDF)
We use the Council for Affordable Quality Healthcare®, or CAQH, to gather and coordinate the information needed for credentialing.
You'll use CAQH ProView to recredential, also called reattestation. It's the process of logging in to CAQH ProView, updating your information if needed, and then attesting, or certifying, that all the information is correct. You're required to reattest every 120 days.
Call us at 1-800-822-2761. Have these things handy for each provider listed on the enrollment form: