Process for New Physicians

Are you hiring a new provider?

If yes, then there are a few steps you will want to take to start the credentialing process:

1. Check to see if the provider is from the area. If so then he/she may be from an existing practice and already participating with many different insurance plans. In that situation many organizations will accept a letter with information concerning effective date of new practice, practice/billing/mailing address, tax id # and a w-9 form. Please check with the payers to see if they have any special form requirements.

2. If provider is new to area or has not been credentialed then you will need to do the following:
A. Contact your local PHO and hospital to request an application
B. Contact Anthem, Aetna or Harvard Pilgrim Health Care to obtain number to start the CAQH credentialing process. CAQH (Council for Affordable Quality Healthcare) is a not-for- profit alliance of health plans. Providers will complete a standard application and it is one application that the provider can designate health plans and hospitals (those that participate) to use. Visit the CAQH website for more information.

3. Complete the appropriate PHO application and return

Important numbers:
MMC PHO - 771-2004
CAQH help desk - (888) 599-1771
Aetna Credentialing Customer Service - (800) 353-1232
Cigna Credentialing Customer Service - (800) 88CIGNA
Harvard Pilgrim Health Care - (800) 708-4414
Health Partners Health Plan/Anthem - (800) 832-6011
Martin's Point Health Care - (800) 348-9804
Synernet CVO - (207) 771-3456