Credentialing FAQ

Practitioners are required to complete the re-credentialing every two years based on their initial credentialing date A provider must successfully complete recredentialing in order to remain a participating provider. CCNV will provide pre-populated recredentialing application months in advance of the required credentialing date. In addition, reminder notices are sent frequently to the practitioner and or credentialing contact. Failure to submit a recredentialing application in time for the credentialing date may impact network health plan participation as well as, FTCA compliance. Please do not wait for last minute submissions.

New providers will be listed in the on-line provider directory within 48 hours of the Board of Directors decision.

Step 1: Request an application- this can be downloaded from www.CCNVA.com

Step 2. Facility/Practitioner submits a completed application with required attachments to CCNV. Please ensure the application is complete- an application deemed incomplete will significantly increase processing times.

Step 3. Our credentialing staff verifies credentials and prepares applicants’ files for review by the credentialing committee.

Step 4: The credentialing committee, which meets on the second Wednesday of each month, determines whether the application is approved or denied. We will notify you of the committee’s decision within 48 hours.

CCNV processes expedited files (rush files). Due to time constraints on staff members, an additional fee is charged for rush files.

Yes. All information received is held in the strictest confidence and secured in locked file cabinets.

Shareholders:
Upon successfully completing the credentialing process, you will receive a letter welcoming you to the network.
External Clients:
CCNV will forward the credentialing contact at the health center the completed application.

The time frame for credentialing varies depending on many variables. However, once a completed credentialing application is received, the credentialing department typically completes the process within 45-60 days.

The process is completed when all elements and queries required by state and federal law have been verified queries are complete.
Shareholders:
Once completed, the Credentials Committee convenes once a month to review all Initial and Recredentialing files. Notification of the Credentials Committee decisions is communicated to the practitioner within 48 hours.
External Clients:
Once the file is completed, the file is sent to the credentialing contact person for review.

CCNV credentials all healthcare practitioners

Credentialing is the process to examine and review professional credentials of healthcare practitioners. Community Care Network of Virginia (CCNV) meets the National Committee for Quality Assurance (NCQA) standards. CCNV verifies licensure, certification, education and experience to confirm the qualifications of healthcare practitioners. Strict credentialing is required to ensure quality and patient safety.

The NPPES has multiple screens that provide for selection of a provider type code and classification name / area of specialization. Certain taxonomy selections will require you to enter your license number and the state where the license was issued. A list of taxonomy selections that require license information is supplied by the application. There are also NPI Application Help screens to assist you.

Visit https://nppes.cms.hhs.gov/NPPES/NPIRegistryHome.do

Several health plans utilize CAQH as a universal provider data source. Health plans download the CAQH application after
the practitioner completes his/her CAQH application and fax the required attachments. CAQH maintains the accuracy of
practitioner data by sending a notice every 120 days to the practitioner for re-attestation. Learn more about the CAQH
website, visit https://upd.caqh.org/oas/

The timeline to get a provider number is not consistent, as it depends upon the health plan/3rd party payer. However a general guideline – based upon a completed application- is between 1 to 4 months.

Please submit all documents via email or fax to the appropriate contact person. Please see the credentialing and provider enrollment contact list.

Please complete or submit indicated items as soon as possible. If you have further questions, please contact CCNV Credentialing Department.

Provider Enrollment starts once the completed application and required attachments are received by CCNV. CCNV will forward the health plan application to the practitioner for review and signature. Once CCNV receives the completed health plan enrollment application, CCNV will forward the information to the applicable health plans in order to collect a Provider ID number. Please allow 30 to 90 days for a health plan to process the application and establish a Provider Number. Health plans have a significant longer processing timeframe for incomplete applications.

Provider enrollment is the enrollment of practitioners with managed care organizations. CCNV provider enrollment department provide application population services for practitioners. CCNV populates data on the health plan applications that are requested by the health center. CCNV forwards the applications to the health center credentialing contact for additional information, review and signatures. Once the health plan applications are completed and returned to CCNV, the applications are forwarded to the health plan to initiate the enrollment process. CCNV performs tracking and routine follow-up with each health plan until a provider number is received.