Credentialing
House Bill 125… How does it effect credentialing?
Adopts the CAQH Credentialing Form.
A physician will only need to fill out one credentialing form, either written or online, and update it as needed. All contracting entities (other than hospitals) seeking to credential a physician must use the same form and cannot request additional information as part of the credentialing process.
What is CAQH?
CAQH, Council for Affordable Quality Healthcare, is a non-profit alliance of health plans. Working in collaboration on initiatives that simplify healthcare administration for health plans and providers, resulting in a better experience for patients and caregivers. All data submitted by providers through CAQH online service or paper application is maintained by CAQH in a state–of-the–art-data center. Providers maintain control of their data at all times. Only they are able to create, add to, change or delete their information through this service. CAQH streamlines the initial application and
re-credentialing process, and offers health plans and networks real-time access to the reliable provider information.
What is the timeframe for processing a credentialing application?
Contracting entities must notify a physician with in 21 days if there is a problem or question with the credentialing form. If the credentialing process is not complete within 90 days, the contracting entity must pay a penalty to the physician.
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