Process
Recredentialing Process:
1. Recredentialing: If you or the provider you credential for are
due to be recredentialed (the participating plans are currently on a
date of birth, two year cycle) you will receive a welcome packet
with instructions for online, mail, or fax (re)attestation, a data
summary (recred profile) and your CAQH ID. A step-by-step checklist
that walks you through the entire process, along with important
background information, will be enclosed for your reference. Even if
it is not time for you to be recredentialed, by completing the
electronic Integrated Massachusetts Application now, you will only
need to update to confirm your information remains accurate when the
time comes.
2. To register, log on to www.caqh.org/cred using the CAQH
Provider ID. Click on “Logging in for the first time,” located on
the right side of the screen. Here you designate your or your
provider’s password and login.
3. HCAS and the participating plans have made the first time
credentialing process as seamless as possible. If you have been
credentialed by one of the plans in the past, you should find that a
majority of your credentialing data has been pre-populated. Please
review this information, add, delete, or make changes as necessary.
Note: You submit one standard application to a
single database that meets the credentialing data needs of the
participating health plans. You can submit your information online,
via a toll-free fax number, or by mail.
• Online: After you register and go through the
online attestation process, you can ‘audit’ the information to make
sure it is complete. Once the information is complete it will be
electronically submitted for centralized credentials verification,
upon completion each plan electronically downloads its providers’
data for approval. Mail/Fax: If you choose to use paper/mail to
attest, once you have mailed/faxed the information requested back to
Ingenix, you will be notified when the process attestation process
is complete.
• Mail/Fax: If you choose to use paper or mail to
attest, once you have mailed/faxed the information requested back to
Ingenix, you will be notified when the process attestation process
is complete.
4. With your permission, participating organizations access your
information and approval according to their respective policies and
procedures.
5. You can update your information at any time and release your
updated information to participating organizations.
Note: You can only transmit your data to
organizations with which you are already contracted or are in the
process of contracting. Using the CAQH Universal Credentialing
DataSource (UCD)does not grant participation or constitute applying
for participation with any organization. If you would like to
participate with any other organizations, you must first contact the
organization(s) directly to request a participation contract.
Each participating organization continues to make independent
decisions as to whether or not you meet its standards for
participation.
Initial Credentialing
When a health plan alerts Ingenix that a new provider would like
to become affiliated, Ingenix will send the provider or
credentialing administrator a welcome kit with a provider ID (i.e.,
username and password). The provider or credentialing administrator
then visits the Web site of the Council for Affordable Quality
Healthcare (CAQH), www.caqh.org, to access the Universal Credential
DataSource (UCD). It is in the UCD that the provider or
credentialing administrator will complete the application.
Physicians and credentialing administrators will use an electronic
version (paper/mail version will also be available for 2 years) of
the Massachusetts Integrated Application for Initial
Credentialing/Appointment, not the CAQH application. The
Massachusetts Integrated Application is a standardized application
launched in 2004 by the Massachusetts Roundtable, an industry
collaborative under the auspices of the Massachusetts Medical
Society. Other clinical staff in Massachusetts will use the
Massachusetts Integrated Application online, which will be adapted
for non-physicians. Outside Massachusetts, providers must use the
CAQH application. Also on the site, providers/credentialing
administrators authorize Ingenix to provide to a specific health
plan, or to all participating health plans, access to their
credentialing data.
The online application is user-friendly, with pull-down menus and
help options. It will take about two hours to complete the initial
application. All information entered in the application is saved, so
the providers/credentialing administrators can leave the site and
return to complete the application in as many sessions as desired.
Once the information is entered and the application is complete, it
is saved in the system, making re-credentialing a much easier and
faster process. Supporting documents that exist in paper form can be
faxed to Ingenix. |
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