Questions regarding Credentialing

How long will it take to process my Credentialing application? Credentialing generally takes 45-120 days for completion.  It may take longer if you submit an incomplete application or if requested attachments are not submitted with the application.  Also depending on the backlog of a carrier, it can take additional time for processing.

I received a letter that my Credentialing application is missing some information. What do I do? You should follow the directions provided. If you have questions you should contact the person who sent the request.  These should be followed up on promptly.

How often are providers Re-Credentialed? Providers are required to complete the Credentialing every three years based on their initial Credentialing date (unless their state has other requirements). A provider must successfully complete Re-Credentialing in order to remain a participating provider.

What happens during Re-Credentialing? After you have been in the network for about 2 ½ years you will receive notification for Re-Credentialing. The notification will include instructions specific to your specialty. If your application is on CAQH and is kept updated, you may not need to take any action at the time of Re-Credentialing.

What if the Credentialing Committee denies my initial application for participation or my Re-Credentialing application? Depending on the reasons why the committee made that decision, you may be offered the opportunity to submit additional information and/or submit an appeal. Your denial or termination letter explains your rights and the timelines you must follow.

What is the submission deadline for the Credentialing/Re-Credentialing forms? There is no deadline to submit an initial Credentialing application but you can’t become a network provider until you have successfully completed the Credentialing process. Re-Credentialing applications should be completed as soon as possible after you receive the notification. If you do not submit a complete Re-Credentialing application, your network participation will be terminated, and you may not be eligible to reapply for two years.

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