Provisional Credentialing During COVID-19
Date: 03/24/20
During the COVID-19 emergency, there is an unprecedented need for care that is straining the capacity of health care systems around the world and in Louisiana.
Credentialing is an important quality check to ensure patients have access to licensed and legitimate providers. In light of this crisis, we are working to expedite credentialing and expand provisional credentialing, to maximize the amount of time and number of providers able to care for patients. This is facilitated by regulatory agencies waiving or extending credentialing requirements.
We want our providers and those who are joining our network to be aware of these important changes to credentialing.
What is provisional credentialing?
Provisional credentialing lets practitioners serve members and be paid for claims prior to the completion of the entire initial credentialing process during the COVID-19 emergency.
How long can a provider be provisionally credential?
In response to the COVID-19 emergency, the National Committee on Quality Assurance (NCQA) announced on 3/18/2020 that it will allow provisional credentialing for up to 180 days. This timeframe will stay in effect until further notice from NCQA.
Who can be provisionally credentialed?
Provisional credentialing is available to practitioners who are applying for the first time to a health plan’s network. A practitioner may only be provisionally credentialed once.
What is required for provisional credentialing during the COVID-19 emergency?
The minimum verification elements needed for Provisional Credentialing are:
A. Current, unrestricted license to practice, if license is required to practice. In response to the COVID-19 Emergency, Health and Human Services announced on 3/18/2020 that if practitioners hold an equivalent license from another state and are not affirmatively barred from practice in that state or any state that is included in the emergency area, they can provide care in any state. This process will stay in effect until further notice from HHS.
B. Complete application form signed and dated by the applicant, including attestation for correctness and completeness of the application. Attestation elements include:
- Reasons for any inability to perform the essential functions of the position, with or without accommodation;
- Physical or mental health problems that may affect the provider’s ability to provide health care;
- Lack of present/current illegal drug use;
- History of chemical dependency/substance abuse;
- History of loss or limitation of license and/or felony convictions;
- History of loss or limitation of clinical privileges and/or disciplinary actions; and
- Current malpractice insurance coverage;
Please note DEA and CDF licensing requirements are not required for provisional credentialing.
All practitioners will be reviewed for:
- Reports of malpractice settlement(s) against the National Practitioner Data Bank (NPDB)
- Medicare/Medicaid-specific exclusions, through the Office of Inspector General.
- State Specific Exclusion Lists, as applicable
- Debarment, suspension or otherwise exclusions from participating in federal procurement activities
How can a provider apply for provisional credentialing?
In order to apply for Provisional credentialing, please complete the standard credentialing packet and label the top as “Provisional Credentialing Request”. Submit completed packets to LHC_Provider_Credent@Centene.com.
If you have questions regarding the Provisional credentialing process please contact: Adam Fruge’ at AFRUGE@LOUISIANAHEALTHCONNECT.COM.