Providers must contract with us before applying for credentialing.
Here’s how it works:
- You must electronically submit a complete HealthCare Administrative Solutions (HCAS) Provider Enrollment Form or a Tufts Health Plan – Network Health Medical or Behavioral Health Provider Information Form to initiate the credentialing process.
- You must make sure you have a complete and current credentialing profile on Council for Affordable Quality Healthcare (CAQH). Once your credentialing profile is complete on CAQH, we begin the credentialing process.
- If we obtain or receive information during the credentialing process that varies substantially from the information you provided in your application, we will notify you of the discrepancy. You have the right to review any information submitted in support of your credentialing application and to correct erroneous information other parties give us (excluding peer-review information). If you dispute the information we have on file, you may file an appeal.
- After our credentialing committee reviews your application, we will let you know of our decision in writing.
Please refer to Chapter 6 in our Provider Manual for more information about our credentialing procedures.
How long does it take?
In most cases, we approve applications that meet all credentialing criteria within 30 days of receipt of a clean, complete application. Call us at 888-257-1985 to ask us about the status of your application. We re-credential all of our providers at least every two years to meet regulatory and accreditation guidelines.
Your right to appeal
You have the right to appeal our credentialing decision.