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Credentialing

Making the credentialing process easy for you

Novant Health ChoiceHealth has delegated credentialing status with all of our payers, which means we have the authority to verify and approve your provider credentials.

Our delegated credentialing services follow NCQA, URAC, federal and state credentialing guidelines and laws and we have been NCQA-certified since 2006. Novant Health ChoiceHealth is required to credential all MDs, DOs, DCs, DPMs and DMDs. Other providers, such as PAs, NPs, 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, and federal and state requirements
  • Review each application to ensure 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 members, if required.

Below is a list of our credentialing relationships. Novant Health ChoiceHealth will also perform traditional credentialing services for any “non-network” payer.

Novant Health ChoiceHealth Credentialing Relationships
Designated Credentialing Plans
Aetna Health, Inc. All Plans
CompCare Network Workers Compensation
Employer’s Choice Network Workers Compensation
Fiedelis SecureCare Medicare
First Health PPO & 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 & POS
Provider Select PPO
USA Managed Care Organization PPO & Behavioral Health
WellPath Select, Inc. All Plans

For more information, contact Alicia Brenseke at:336-277-1602.