Recredentialing process

We recredential providers every three years.

Reattesting your CAQH application

Before you submit your updated CAQH application, go to our online provider directory, Find a Doctor, and review the information there. Update your CAQH application with any new/changed locations, hours, phone numbers, office hours, web addresses, hospital affiliations, etc., because we use your CAQH application to update the online provider directory.

To request updates to our online provider directory:

  1. Log into your prism account
  2. Click Enrollments & Changes
  3. Click Change Individual Provider or Organization
  4. Follow the directions as indicated

Recredentialing process

During recredentialing, we review your:

  • Reattested CAQH application (CAQH requires re-attesting every 120 days. If you don't re-attest according to their guidelines, we may be unable to recredential you and you'll be subject to contract termination)
  • Board certifications
  • State and federal licenses
  • Hospital memberships
  • Disciplinary, malpractice and sanction verifications
  • Medicare opt-out report
  • Proof of liability insurance

Provider rights in the recredentialing process

  • You have the right to review information submitted in support of your application
  • You have the right to correct erroneous information submitted by another party

These rights are fully described in the Priority Health Practitioner Rights Policy.