The Credentialing Process

Providers must complete the credentialing process and receive approval from Priority Health prior to seeing Priority Health members.

• The application process
  
• Credentialing criteria by provider type
• Credentialing criteria for organizational providers
  
• Adding a new provider to an existing practice
• Recredentialing a practice
• Provider rights in the process (23KB PDF)
• Credentialing policies covering the processes

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Provider responsibilities
Throughout the credentialing process, the applicant or practitioner is responsible for:

a. Responding to requests for information made by Priority Health's credentialing staff, the Credentialing Committee, Quality Integration Committee, or Board of Directors; and

b. Keeping Priority Health informed of any changes in his or her status relative to the criteria.  For example, a practitioner should notify the Committee regarding any:

• Judgment, settlement, or compromise in a professional liability action;
• Action limiting or suspending the practitioner's license to practice a profession, or his or her authority to prescribe medication;
• Exclusion from the Medicare or Medicaid programs;
• Cancellation of professional liability coverage; or
• Loss or significant curtailment of clinical privileges at a licensed hospital.