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. Note: This application MUST include current state licensure, current liability insurance, and 24/7 covering colleague(s)

  3. Complete the Priority Health Provider information form.
  4. Complete an IRS Form W-9, Taxpayer Identification Number and Certification.
  5. Email your Provider information form and W-9 to:

  6. We will send you a confirmation email that will include next steps, and any requests for additional/missing information.

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 8 to 12 weeks. 

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
  • 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.