ChoiceHealth's delegated credentialing services follow NCQA, URAC, federal, and state credentialing guidelines and laws. Novant Health ChoiceHealth is required to credential all MD's, DO's, DC's, DPM's. Other providers, such as PA's, NP's, and Therapists, etc., are credentialed at the discretion of the practice.
Our credentialing processes include, but are not limited to, the following:
- Maintain current knowledge of and ensure compliance with NCQA standards, URAC standards, federal, and state requirements
- Review application to ensure that it meets administrative requirements
- Ensure the application is complete within 15 days of receipt. Inform provider in writing of any deficiencies
- Obtain relevant documents (with the applicant's assistance, if necessary)
- Conduct primary source verification
- Prepare file for review
- Conduct site visits, where applicable
- Complete credentialing process within 60-day time frame
- Inform provider of decision
- Inform managed care companies of decision
- Update credentials file at the time of re-credentialing
- Facilitate access to the appropriate provider numbers, if required
- NCQA certified since 2006.
Our Credentialing Relationships
- AETNA Health, Inc.: all plans
- CompCare Network: Workers Compensation
- Employer's Choice Network: Workers Compensation
- Fiedelis SecureCare: Medicare
- First Health: PPO and Workers Compensation
- Humana dba ChoiceCare Network: PPO
- Medical Mutual of Ohio: PPO
- Multiplan, Inc.: PPO
- Premier Health Systems: PPO
- Primary PhysicianCare: PPO
- Private Healthcare Systems: PPO and POS
- Provider Select: PPO
- USA Managed Care Organization: PPO and Behavioral Health
- WellPath Select, Inc.: all plans.
ChoiceHealth will perform traditional credentialing services for any "non-network" payor.
For More Information Contact:
Novant Health ChoiceHealth
2085 Frontis Plaza Blvd.
Winston-Salem, NC 27103