Credentialing application process

Before you begin

Once you determine that Priority Health requires credentialing for your provider type, you must register with the Council for Affordable Healthcare (CAQH) to start the credentialing process. If you are not yet registered:

Register now

Or, you may call them at 888.599.1771 to register.

Contact the Priority Health Provider Contracting department to make sure we have a contract on file, either for your group or for yourself prepared and waiting for your credentialing to be confirmed.

Next, submit your documents

  1. Complete the online credentialing application at the CAQH website.
  2. Use our new intake process to complete the Provider Information form and IRS W-9 form.
  3. We will send you a confirmation email that will include next steps, and any requests for additional/missing information.

Our workflow for getting your questions answered

When we receive your complete credentialing information, it will take us a maximum total of 62 calendar days for us to process your request. This does not include additional time for contracting.

We work hard to process your requests in a timely manner. Each step in our credentialing process takes time and we have made an effort to allocate a designated number of calendar days for each team processing your request. Our credentialing process takes 37 calendar days, followed by 18 calendar days for provider enrollment, and 7 days for provider reimbursement equaling a total of 62 calendar days to complete your request.

We recognize that every request is unique, and not all workflow steps may be required to complete your request. Below is a diagram that was created to show you what step within the process your request is at in our workflow.

After a request is submitted, you'll receive an initial email, letting you know we've received your request and indicating the workflow step your request is in. You'll also get an inquiry number associated with the request. Keep the inquiry number in a safe place, because it will help us locate your request if you have questions.

Following this initial communication, you'll receive updates from us at each step in the process, letting you know the status of your request, including any action items or additional information we need from you (if applicable).

If it is determined that a contract is needed, your contract administrator will contact you directly to determine your contract needs.

*Note: the contracting processing time is not within our workflow processing timeframe above.

Once your request is complete, you'll receive a final communication from us that includes your effective date. You can begin billing for dates of service on the effective date. Claims submitted before the effective date may result in incorrect payment or denial.

We have created a new email for you to utilize in the event your request has gone over our processing time frames. The email address is Exceedsprocessingtime@priorityhealth.com. Be sure to include your inquiry number within your status update.

Applicant responsibilities

Throughout the credentialing and enrollment process, the applicant or practitioner is responsible for:

  1. Responding to requests for information made by Priority Health credentialing staff, the Credentialing Committee, Quality Integration Committee, or Board of Directors; and
  2. 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.

Our review

We review your application and supporting documents for completeness and verify your information. This process takes 62 calendar days. 

Your application is complete when Priority Health has received, verified and/or completed the following:

  • Completed application and signed attestation and release, including copies of professional liability insurance (minimum limits of $100,000/ $300,000)
  • Professional liability claims history, verified directly with the National Practitioner Data Bank
  • Applicable state and controlled substance licenses, verified through the state departments of licensing
  • Federal DEA license verified
  • Graduation from medical school, verified directly with the medical school or by the American Board of Medical Specialists (ABMS) or American Osteopathic Association (AOA) listings
  • Residency and fellowship (if applicable) verified directly with the training program or by the ABMS or AOA listings
  • Board certification, verified with the ABMS, AOA, American Board of Podiatric Surgery, American Board of Podiatric Orthopedics and Primary Podiatric Medicine, American Board of Oral Surgery, American Board of Sleep Medicine, or American Board of Addiction Medicine listings (see individual criteria for exceptions)
  • Current and previous hospital memberships, verified by mail, fax and/ or phone
  • CHAMPS enrollment verified, Medicaid only
  • Medicare Opt-out Report
  • National Practitioner Data Bank (NPDB), queried online to verify any disciplinary actions, malpractice payments and Medicare/ Medicaid sanctions
  • MDCH - Medical Services Administration Sanctioned Providers
  • Office of Inspector General Sanctioned Provider Exclusion Database
  • System for Award Management (SAM)
  • Letters of recommendation, if requested, from physicians who are familiar with the applicant's clinical skills and who are not employed with or partners of his or her prospective physician group

Approval & denial

The Credentialing Committee approves or denies your application.

You have the right to review certain information submitted in support of your application and to amend erroneous information submitted by another party. These rights are fully described in the Priority Health Practitioner Rights Policy.