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Managed Care Credentialing
| Delegated and traditional credentialing services are available to healthcare providers that are members of ChoiceHealth. We will complete the credentialing applications, track the process and let you know when the credentialing is finalized. |
ChoiceHealth's delegated credentialing services follow NCQA, federal, and North Carolina Credentialing guidelines and laws. In order to assure compliance with North Carolina law, ChoiceHealth credentials the following types of providers: Optometrists, Podiatrists, Certified Clinical Social Workers, Certified Substance Abuse Professionals, Licensed Professional Counselors, Dentists, Chiropractors, Psychologists, Pharmacists, Certified Fee-based Practicing Pastoral Counselors, Advanced Practice Nurses, Physician Assistants, Respiratory Therapist, Occupational Therapist, Physical Therapist, Registered Dietician and Physicians.
Our credentialing processes include, but are not limited to, the following:
- Maintain current knowledge of and ensure compliance with NCQA standards and state and federal 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
Delegated Credentialing
- AETNA Health of the Carolinas PPO, POS, EPO, HMO
- Cigna HMO, POS, PPO (Available to Novant-employed providers only)
- Coventry HMO,POS (Available to Novant-employed providers only)
- FirstHealth PPO, Workers Compensation
- Great West Healthcare HMO, POS, PPO
- Humana PPO
- Kanawha Benefit Solutions PPO
- MedCost PPO (Available to Novant-employed providers only)
- Multiplan PPO
- Primary Physician Care PPO
- Private HealthCare Systems POS, PPO
- USA Managed Care Organization EPO, PPO
- Premier Health Systems PPO
- Provider Select PPO
- WellPath Select Inc.
ChoiceHealth will perform traditional credentialing services for any "non-network" carrier for an additional fee.
For More Information
Contact our credentialing staff for details:
ChoiceHealth
2085 Frontis Plaza Blvd.
Winston-Salem, NC 27103
336-277-1143 or 336-277-1065
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