Your credentialing team is responsible for credentialing providers with each payer. The provider rosters that CHPA collects are for attribution only and do not credential the providers that are added or terminated from your provider roster. We’ve put together the following information for you to help guide what happens with each payer.
MSSP: It is critical for your member attribution and member assignments that you maintain your providers in the PECOS system. CMS pulls all NPIs assigned to your TIN in PECOS for the MSSP Program attribution. This means you are responsible for those patients assigned to you. Example: when we send you a list and the response is: ‘that provider hasn’t been with us in X years’, as far as CMS is concerned, that provider NPI is still tied to your TIN and you are responsible for that member. To add or remove providers in PECOS, you will use the following form. Link
Bright Health Credentialing: Your credentialing team should email providerdataco@brighthealthplan.com to credential your providers. The credentialing team will then refer you to their credentialing portal ‘Aperture’ to complete the credentialing.
Cigna Credentialing: They require you to complete their application to add providers. They primarily use CAQH, but FQHCs are credentialed at the facility level. For additional information and process, please use this link: https://www.cigna.com/health-care-providers/credentialing/join-medical-network
Humana Credentialing: Email provider rosters to coloradomexico@humana.com. For additional information and process, please use this link: https://www.humana.com/provider/medical-resources/join-humana-network/credentialing-facilities-and-organizations
Anthem Credentialing: You will need to register for access to the Availity system to complete credentialing online. Additional information here: https://www.anthem.com/provider/availity/?cnslocale=en_US_co
Please contact Joseph Berry with any additional questions.
