Recredentialing process

Providers are automatically recredentialed every three years. A provider won't be notified unless there's information missing from their CAQH application. If you're contacted, you must update your CAQH in a timely manner and respond to the credentialing analyst’s email request with this update. We're not notified by CAQH when an application has been updated. 

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

It's important that your Credentialing Contact information is updated on your CAQH. It's recommended to include email addresses and phone numbers in the event communication is needed. 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 license (ensuring name matches between state licenses and NPPES)
  • Hospital memberships
  • Disciplinary, malpractice and sanction verifications
  • Medicare opt-out report
  • Proof of liability insurance (must include dates and limits)

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.