Re-credentialing

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INDIVIDUAL RE-CREDENTIALING

All participating individual providers are re-credentialed within 36 months.

Six (6) months prior to the provider’s re-credentialing date, CAQH (the Council for Affordable Quality Health) will be utilized to gather the information needed. All CAQH profiles should be kept up to date and attested to, and Brighton Health Plan Solutions should have permission to access the profile. If all information is current, re-credentialing will be completed. Once approved by our Provider Credentialing Committee, a letter will be mailed notifying of the re-credentialing approval.

If the provider’s profile is not complete or attested, or cannot be accessed, a letter will be generated and sent to the most recent credentialing contact. If there is any missing information for re- credentialing, our best efforts will be made to collect what is needed. Failure to respond to missing information needed for re-credentialing may result in termination from the plan.

ORGANIZATIONAL RE-CREDENTIALING:

All participating groups are re-credentialed within 36 months.

Six (6) months prior to the re-credentialing date, an application will be sent to the credentialing contact on file. The completed application with all requested documents should be returned to [email protected] in timely manner.

After review by the network team and the Provider Credentialing Committee, a decision will be made and the notification will be forwarded.

If there is any missing information for re-credentialing, our best efforts will be made to collect what is needed. Failure to respond to missing information needed for re-credentialing may result in termination from the plan.