Credentialing

Application status

We are now processing credentialing applications submitted on or before October 21, 2022. Completion of the credentialing process takes 30-60 days. We will notify you once your application has been approved or if additional information is needed. View your credentialing status in Payer Spaces on Availity Essentials.

We contract with physicians, dentists, other health care professionals and facilities to form provider networks essential for delivery of health care and dental services to our members. All providers must be credentialed before they can participate in our provider networks.

We require all providers to meet our credentialing criteria prior to contracting and remain in compliance with that criteria at all times.

  • Providers must be licensed in the Asuris service area.
  • Providers must be physically located in the Asuris service area.
    • Providers who conduct telehealth services from their homes can use a registered agent address.
    • The provider’s address cannot be a P.O. box.

Application checklist

Before submitting a credentialing application, confirm:

  1. We contract with your provider specialty type
  2. Our networks are open to participation
  3. You meet our credentialing criteria for participation and termination:
  4. You include a CP 575 or 147C letter and other required documents noted on the application

Notes:

  • If a new provider is joining your practice, call our Provider Contact Center to see if that provider has an active credentialing record with us before submitting an application.
  • If you have changes to your practice information or location, do not submit a credentialing application. Notify us of changes by completing the Provider Information Update Form.

After submitting a credentialing application:

  • Complete all required onboarding tasks:
    • Register for Availity Essentials
    • Enroll for electronic funds transfer (EFT)
    • Submit tax documents
  • Use our provider onboarding resource to complete required tasks and become familiar with tools and resources that help you quickly get started with us.

Note: Agreements will not be issued until successful credentialing and all required onboarding tasks have been completed.

Verification of Tax ID

You must include a copy of your CP 575 or 147C letter, obtained from the Internal Revenue Service (IRS), to complete your credentialing application. Note: Do not use your Social Security number for billing purposes.

  • The CP 575 is generated by the IRS when an Employee Identification Number is granted. Replacement CP 575 letters cannot be generated; a 147C letter contains the same information as the original CP 575.
  • Request a 147C letter by phoning the IRS at 1 (800) 829-4933 during normal business hours. You can elect to receive the 147C letter via fax or email.

Submit a credentialing application

Physicians, dentists and other health care professionals

Complete a credentialing application using one of two methods:

  1. Complete our online application using ProviderSource® Note: If you use this service to complete an application, please notify our Credentialing department.
  2. Download an application (PDF) and return it along with required documents noted on the application. Submit your 147C or CP 575 by email or fax to 1 (888) 335-3002.

Notes:

  • The Credentialing email is only to be used for the submission of initial credentialing or recredentialing applications.
  • If you have changes to your practice information or location, do not submit a credentialing application. Notify us of your changes by completing the Provider Information Update Form.
  • Behavioral health providers: If you have changes to your areas of clinical focus or modalities, please complete the Behavioral Health Practitioner Areas of Clinical Focus Form.

Organizations and facilities

Complete an Organizational Provider/Facility Credentialing/Recredentialing Application (PDF) and return it along with required documents noted on the application. Submit your 147C or CP 575 by fax or email.

Notes:

  • The Credentialing email is only to be used for the submission of initial credentialing or recredentialing applications.
  • Organizational providers that have changed ownership and are required to complete the site survey process by the state and Medicare must be initially credentialed under the new ownership. If the state and Medicare allow the acquisition without the application and site survey process, credentialing may not be required.

Hospital and free-standing facility based practitioners

This applies to a practitioner who practices exclusively within a hospital, inpatient or free-standing facility setting.

Complete the Hospital and Free-Standing Facility Based Practitioner Information Form (PDF) and fax to 1 (888) 289-1313.

Please note: If you move from practicing within a hospital, inpatient or free-standing facility setting to a clinic setting, you will be required to submit a credentialing application.

Behavioral health facilities

Please also review our Behavioral Health Medical Policies and complete our Behavioral Health Facility Assessment form. Note: Completion of the Behavioral Health Facility Assessment form does not affect the credentialing process or the outcome of your credentialing.

The information you share on the form about your facility’s specialties and demographics served helps us fully understand the services available. Presenting those to our members allows them to make informed decisions about their health care and who they select for services.

Initial credentialing process

Upon receipt of a completed credentialing application, we verify the information using national and state data sources. Incomplete applications will delay the process.

You will receive an email confirming receipt of your application and instructions for completing required onboarding tasks. These tasks include:

  1. Registering for Availity Essentials
  2. Enrolling for EFT
  3. Verifying your tax ID by faxing a copy of your 147C or CP 575 to 1 (888) 335-3002
  4. Signing agreement documents

Note: Providers who are joining an existing agreement for a contracted tax ID may not need to complete some tasks.

  • Agreements will not be issued until successful credentialing and all required onboarding tasks have been completed.
  • Within 10 business days of signing your agreement documents, you will be loaded to our system as a participating provider. You will receive an email notification that confirms your participation on our network(s) and includes your effective date of participation.
  • If you are joining an existing agreement for a contracted tax ID, you will be added to that agreement and will not have to sign agreement documents. The tax ID owner will be notified of your network participation effective date.
  • Claims submitted before your effective date of participation will be processed as out-of-network.

Participation effective dates

  • If you are a newly credentialed provider joining an existing contracted group, upon the approval of your credentialing, the effective date of your participation will be the date your credentialing application is considered complete, which is determined as part of the credentialing approval process.
  • If you are a newly credentialed new-to-Asuris provider, the effective date of your participation will be based on when your contract agreement is signed.

Learn more about the contracting process, including how to determine your effective date and how to sign up for eContracting.

Telehealth service provider credentialing

You are eligible to be credentialed and contracted as a network provider if you are:

  • Licensed in the Asuris Northwest Health service area, and
  • Reside AND conduct telehealth services within our service area (home or clinic location), or
  • Reside outside our service area but physically conduct telehealth services from a location within our service area (e.g., clinic setting).

If you reside and provide telehealth services at a location outside of our service area, we are unable to contract with you.

Type of service

In person

In person

Virtual/telehealth

Virtual/telehealth

Virtual/telehealth

Place of service

Services are delivered inside our service area (clinic)

Services are delivered inside our service area (clinic)

Services are delivered inside our service area (home or clinic)

Services are delivered inside our service area (clinic)

Services are delivered outside our service area (home or clinic)

State licensure

Inside our service area

Inside our service area

Inside our service area

Inside our service area

Inside our service area

Member location

Inside our service area

Inside our service area

Inside our service area

Inside our service area

Inside our service area

Credentialing and contracting eligibility

Eligible

Eligible

Eligible

Eligible

Not eligible

Credentialing status

The Onboarding Tracker gives you at-a-glance status of your onboarding progress and includes completed and outstanding required tasks. View the Onboarding Tracker on Availity Essentials: Payer Spaces.

Other helpful reports are available on Availity Essentials: Payer Spaces>Asuris>Applications>Provider Reports-for your organization>Credentialing & Maintenance Reports:

  • Credentialing Status Report - credentialing and recredentialing status information for providers in your organization
  • Returned Centers for Medicare & Medicaid Services (CMS) Validation Roster - a copy of the CMS Provider Validation spreadsheet that you sent back to us
  • Provider Roster - a copy of the Centers for Medicare & Medicaid Services (CMS) Provider Validation spreadsheet that we send to you

Recredentialing

All credentialed providers must remain in compliance with credentialing criteria at all times and must complete the recredentialing process every three years to continue network participation.

Providers whose contract status has lapsed more than 30 days will be required to resubmit an initial credentialing application. Not having an active practice location is considered a lapse.

The recredentialing request is sent approximately three to six months prior to the recredentialing due date. All providers are expected to respond to this request in a timely manner. Upon receipt, the application is reviewed using national and state data sources. Additional information reviewed may include, but is not limited to, member complaints and quality improvement activities. You have the right to correct erroneous information submitted by another source. Please contact the Credentialing department to learn more.

Notes:

  • The Credentialing email is only to be used for the submission of initial credentialing or recredentialing applications.
  • Failure to return recredentialing documentation in required timeframes will result in the removal from provider directories and termination of the provider's network participation. Providers who have their participation terminated must wait one year before reapplying for network participation.

After completing the recredentialing process, providers will only be contacted by the Credentialing department in the event of an adverse decision or conditional approval status. Providers must agree to these conditions in order for contracts to be maintained.

Providers who have been terminated from network participation, including adverse decisions due to quality reasons or altering conditions of participation have the right to appeal. Refer to the Provider Contract Termination Appeals process for additional information. Providers who leave a delegated entity must notify us and are subject to recredentialing guidelines.

Behavioral health facilities
In addition to completing information for your recredentialing, please review our Behavioral Health Medical Policies and complete our Behavioral Health Facility Assessment form. Note: Completion of the Behavioral Health Facility Assessment form does not affect the credentialing process or the outcome of your credentialing.

Delegated Credentialing

We may delegate credentialing activities to contracted provider groups whose membership includes a minimum of 150 providers. Provider groups must demonstrate the ability to meet our performance standards. Credentialing for organizational providers and facilities cannot be delegated. Asuris retains the right to approve new providers and facilities and to terminate or suspend individual providers as necessary and appropriate.

Indian or Tribal Health Clinic credentialing requirements

We require that all Indian or Tribal Health providers complete the credentialing process prior to contracting. These providers are required to complete the recredentialing process at a minimum of every three years.

Provider rights

Providers have the right to review information submitted to support their credentialing application, including review of information submitted from outside sources (for example, malpractice insurance and state licensing boards). Providers may also request information about the status of his/her application or reapplication. All requests should be submitted to the Credentialing department by email. Application status requests are responded to and tracked in the provider's credentialing file. Information that is allowed to be shared includes the current status, outstanding requests and process timeframes. Peer-protected and confidential information prohibited by law cannot be disclosed.

In the event that erroneous or conflicting information is discovered in a credentialing application, the provider will be notified in writing of the right to dispute and/or correct the information (subject to any restrictions provided by a verification source, or otherwise prohibited by law). The provider must submit a detailed explanation of all clarifications and corrections in writing, within fifteen (15) business days of the request, to the Credentialing department via email or by fax at (888) 335-3002. The credentialing staff documents receipt of corrected credentialing information in the provider's credentialing file.

Note: The Credentialing email is only to be used for the submission of initial credentialing or recredentialing applications.

If you are already credentialed

You are required to verify your information in our directories every 30 days. Follow these steps to review your directory listing.

Resources