Credentialing guides
What each insurance plan actually asks for, which number to call, and how long it takes. Written from applications we've filed for nurse practitioners and behavioral health practices.
How long does insurance credentialing take?
Real credentialing timelines for nurse practitioners: CAQH, Medicare, Virginia Medicaid plans, Aetna, Optum, Carelon, Humana and Sentara, and what slows each one down.
Virginia Medicaid credentialing for nurse practitioners
How NPs and behavioral health practices join Virginia Medicaid (Cardinal Care): DMAS enrollment, the PRSS portal, and each managed care plan's own process.
Aetna credentialing: joining the network and changing your tax ID
How NPs join Aetna, and how a group with an existing Aetna contract changes its tax ID through Availity, with the phone numbers and fax that actually work.
Humana Healthy Horizons in Virginia: how to join, and what to do if you're denied
How behavioral health providers join Humana Healthy Horizons in Virginia (Medicaid), what the Request to Join needs, and how a closed-network denial was overturned.
Sentara Health Plans credentialing for behavioral health
How to request to join Sentara Health Plans' behavioral health network in Virginia while it's closed: the forms, where to send them, and how status works.
Optum Behavioral Health credentialing: Provider Express, tax ID changes and adding networks
How NPs work with Optum Behavioral Health (UnitedHealthcare): Provider Express, the tax ID change form, why commercial networks can get left behind, and how to add them.
Carelon Behavioral Health credentialing (Anthem's behavioral health network)
How behavioral health NPs get credentialed with Anthem through Carelon: Availity enrollment, the contract, phone menu shortcuts, and which Blue plan covers your area.
CAQH ProView: what nurse practitioners need to do, and how often
Set up and maintain CAQH ProView: documents, authorizing plans, re-attesting every 120 days, and how a Practice Manager account exports practice data to your profile.