Improving provider credentialing and change requests turnaround times
We’re working to fix our delayed processing times on your provider enrollment and change requests.
We know we’re not meeting your expectations or ours right now. We recognize how challenging this is for your practices and the impact these delays have on accurate claims and incentive program payments. We’re committed to improving turnaround times with our backlog resolved by the first quarter of 2022.
- New provider credentialing includes first-time applications by providers who have never been reimbursed as an in-network provider by us.
- Changes should be requested when there are updates to an existing application or provider profile, such as addresses or phone number updates or when a provider moves offices or hospital affiliations.
Our action plan
These are the steps we’re taking to work through our backlog as quickly as possible:
- Processing the oldest applications first: We operate on a first in-first out processing order. The oldest applications are processed first once all necessary information is received. After an initial request is submitted, you’ll get an email in five to seven business days when your application is in process, and the email will have your inquiry number. As requests are processed, we’ll contact you if additional information is needed. Once an application is completed, we’ll send a confirmation email.
- Working with a vendor to support provider credentialing and enrollment: We’ve contracted with Symplr CVO to help us expedite provider enrollments.
- Status requests won’t receive replies: To help us return to service levels, we won’t be responding to status requests at this time. Sending multiple emails requesting a status delays our response time.
Use prism for requests and status updates
We recently launched prism, where you can more quickly and easily request credentialing and changes. There you can also see the status of your requests, anytime, right in prism without having to call us. To learn more about how to submit credentialing and change requests, watch the “Enrollments & Requests” demo video in our prism resources webpage. To see the status of your requests, follow these steps:
- Log into your prism account
- Click “Enrollments & Requests”
- Review the informational chart, which lists all your requests. Find the “Status” column to see where your request is at in our process.
Stay up to date on our progress
Check our provider news for updates on our improvement efforts. Our credentialing web page will also list the submission month we’re processing. This will help you determine if your submission will be processed soon.
We appreciate your patience
Thank you for your partnership with Priority Health.