Our providers must be both contracted and credentialed before they can join our network.
Our provider contracting department generates the contracts that govern the terms of the provision of health care services to members. These contracts also include the reimbursement rate for medically necessary services.
The credentialing process begins after we initiate a provider contract. Credentialing is a method to select and evaluate practitioners and facilities based on the National Committee for Quality Assurance (NCQA) standards and our credentialing criteria. During the process, many items are primary source verified, such as licensure, DEA certification, education and board certification. Recredentialing occurs at least every three years. Providers who are being added to existing contracts also need to be credentialed. Credentialing is separate from validation by the state. As part of our process, all providers must be currently validated with the state before we can complete our credentialing process.
If you are not contracted and are interested in becoming a provider in our network, please email firstname.lastname@example.org.
We use the Council for Affordable Quality Healthcare (CAQH), which houses credentialing documentation. If you are not currently participating with CAQH, but would like to join, please email: email@example.com. CAQH is a free service for providers.
If you have questions regarding credentialing, email firstname.lastname@example.org. If you have questions about the provider contracting process, email email@example.com. You can also call us.
About CAQH Universal Credentialing DataSource (UCD):
This web-based tool enables providers to enter their credentialing information online.
- If you would like more information about registering for the service or completing the UCD application, please visit https://upd.caqh.org/oas/.
- If you already participate with CAQH, be sure to designate Colorado Access as an authorized health plan.
The credentialing process must be finished before a contract is finalized and executed.