Credentialing

Application status

We are now processing credentialing applications submitted on or before March 9, 2020. 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 the Availity Provider Portal.

Credentialing

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. Only those applicants licensed in Washington and in those specialties recognized by Asuris will be considered.

Note: Locum tenens do not require credentialing

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:
    1. Physicians and other health care professionals
      1. Effective April 1, 2019 (PDF)
    2. Organizations and facilities
      1. Effective April 1, 2019 (PDF)
  4. You have a CP 575 or 147C letter
  5. You have registered for the Availity Provider Portal to check credentialing status, member benefits and eligibility, and claims remittance advice
  6. You have registered for electronic funds transfer

If a new provider is joining your practice, please ask our Provider Relations department 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.

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: If you are billing using your Social Security Number, you will need to submit a W9.)

  • 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 your 147C or CP 575 by fax or email.

Notes:

Organizations and facilities
Complete an Organizational Provider/Facility Credentialing/Recredentialing Application (PDF) and return it along with your 147C or CP 575 by fax or email.

Note: 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)

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 application, we verify the information using national and state data sources before reviewing for final approval. Incomplete applications will delay the process.

You will receive an email confirmation once you have passed successful credentialing. You will then receive instructions for signing your agreement documents which will complete the contracting process. After credentialing is approved, we will extend an agreement for signature. The effective date of your participation will be based on when the contract is signed. Learn more about the contracting process.

Credentialing status

View your credentialing status and other reports on the Availity Portal: Payer Spaces>Asuris>Applications>Provider Reports-for your organization>Credentialing & Maintenance Reports.

Reports available:

  • 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.

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.

Note: 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.

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

Questions?

Our Provider Relations department can answer questions about: TIN, eContracting process, accessing agreement documents, effective dates, networks status, billing and directory issues. Select the Provider Relations tab to contact your Provider experience representative.