Credentialing a new provider

When a new provider (not currently a participating Priority Health provider) joins your practice our goal is to complete the credentialing process within 45 days. During the credentialing process, please provide needed information in a thorough and timely manner. This includes making sure the CAQH application is acessible and updated. The credentialing committee meets the first Wednesday of each month to review completed applications, and we’ll notify you when the provider has been approved. Until you receive that notification, the provider will be considered not participating for HMO and Medicaid members and out-of-network for members having POS, PPO, or Medicare coverage. Claims from non-participating providers are denied as member liability. If you have questions about this process, please contact your PAC or PAR.

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