Credentialing
Credentialing with Healthy Blue
Credentialing is the process Healthy Blue uses to evaluate and select licensed independent practitioners to provide care to our members. Healthy Blue uses the Council for Affordable Quality Healthcare (CAQH) ProView application for credentialing. This secure and private website reduces the amount of paperwork you need to fill out to complete the credentialing process.
Credentialing Overview
Why do we credential?
Credentials are evaluated according to criteria set forth in our policy to ensure the competency and conduct of the healthcare professionals serving members in our network.
Who do we credential?
We credential licensed healthcare professionals with whom the company intends to contract and market to our members. Our Program Summary includes a complete list of provider types we credential and those we do not.
Please note: Facilities (health delivery organizations) may also need to be credentialed before joining the network.
Credentialing Process
- Register with CAQH (if you are not already registered). You may self-register by visiting proview.caqh.org. This is a secure and private website
- Authorize Healthy Blue so we can access your credentialing information. If you are already registered with CAQH, you will need to give us permission to review your information
- If you need assistance, please review the New Provider Quick Reference Guide or call the CAQH Provider help line at 888-599-1771.
- Review and update your application. Please ensure all sections of the application are complete and accurate.
Credentialing application requirements
The credentialing process typically takes 45 days from the time the credentialing department receives your completed CAQH application.
Recredentialing
Healthy Blue recredentials network providers every three years. If your CAQH application is current and complete at that time, no additional effort on your part may be required. If CAQH is expired or missing information, we will contact you to update the information.
Non-response to recredentialing request
If you do not update CAQH or supply the required information for recredentialing by the due date, your application will be considered incomplete and will result in an administrative termination from the network.
Care provider rights
Care providers have the right to:
- Review information submitted to support their credentialing application.
- Correct erroneous information.
- Receive the status of their credentialing or recredentialing application upon request.
For a complete list of your credentialing rights as a provider, please review the Practitioner Credentialing Rights. To review your application or correct submitted information, please email our credentialing team at Credentialing@healthybluekansas.com.
Already in our network?
If you are an existing contracted provider with Healthy Blue and you have a question about your network status or participation, please contact our Health Care Networks team.