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. Cenevia 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.

Health plans will be notified of new providers within 48 hours of the Credentialing Committee decision.  Directory updates are health plan specific.

Step 1: Request login access to the eApply website or request a manual application.

Step 2. Practitioner submits a completed digital or manual application with required attachments to Cenevia. Please ensure the application is complete, as a partial application 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 reviews files weekly to determine whether the application is submitted for health plan participation. We will notify you of the committee’s decision within 48 hours.

Cenevia processes expedited files (rush files); 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, the provider, the credentialing contact, and the designated leadership of the facility will receive a letter welcoming the provider to the network.
External Clients:
Cenevia 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 15-30 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 weekly to review all Initial and Recredentialing files. Notification of the Credentials Committee decisions is communicated to the practitioner and to the client within 48 hours.
External Clients:
Once the file is completed, the file is sent to the credentialing contact person for review.

Cenevia credentials all healthcare practitioners

Credentialing is the process to examine and review professional credentials of healthcare practitioners. Cenevia (Cenevia) meets the National Committee for Quality Assurance (NCQA) standards. Cenevia verifies licensure, certification, education and experience to confirm the professional credentials of healthcare practitioners. Strict credentialing standards are 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.  (Source: (http://www.dmas.virginia.gov/npi-FAQ.htm)

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

Many 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 90 days to the practitioner for re-attestation. To learn more about the CAQH website, visit: https://upd.caqh.org/oas/

The timeline to complete enrollment 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 Cenevia’s Credentialing and Enrollment Department using the “Contact” link on the sidebar.

Provider Enrollment starts once the completed application and required attachments are received by Cenevia. Cenevia will forward the health plan application to the practitioner for review and signature when applicable. Once Cenevia receives the completed health plan enrollment application, Cenevia will forward the information to the health plans to begin the enrollment process. Please allow 1 to 4 months for a health plan to process the application and establish a provider as enrolled.

Provider enrollment is the enrollment of practitioners with health plans. Cenevia’s provider enrollment department provides application population services for practitioners. Cenevia populates the provider data on the health plan applications that are requested by the health center. Cenevia forwards the applications to the health center credentialing contact for review and signatures. Once the health plan applications are completed and returned to Cenevia, the applications are forwarded to the health plan to initiate the enrollment process. Cenevia performs tracking and routine follow-up with each health plan until a provider is enrolled.