NCQA: Practitioners’ Rights during Credentialing Process

The credentialing process must be completed before a practitioner begins seeing members and enters into a contractual relationship with a health care insurer. As part of our credentialing process, practitioners have certain rights as briefly outlined below.

 

Practitioners can request to:

• Review information submitted to support their credentialing application.

• Correct erroneous information regarding a credentialing application.

• Be notified of the status of credentialing or recredentialing applications.

 

The Council for Affordable Quality Healthcare (CAQH®) universal credentialing process is used for all providers who contract with Anthem Blue Cross and Blue Shield (Anthem). To apply for credentialing with Anthem, go to the CAQH website at https://www.caqh.org and select CAQH ProView™. There is no application fee.

 

We encourage practitioners to begin the credentialing process as soon as possible when new physicians join a practice. Doing so will help minimize any disruptions to the practice and members’ claims.