Care1st and ONECare are members of the Arizona Association of Health Plans (AzAHP) and participate in the AzAHP Credentialing Alliance whose aim is to make the credentialing and recredentialing process easier by eliminating duplication of efforts and reducing administrative burden.
The Credentialing Alliance's streamlined credentialing process utilizes the Council for Affordable Quality Healthcare (CAQH) Universal Provider Datasource for all practitioner credentialing applications for all participating plans and a common paper application for all facility credentialing applications. The Credentialing Alliance also uses a common practitioner data form and organizational data form to collect information necessary for their contract review process and system loading requirements.
The Credentialing Alliance uses Aperture Credentialing for primary source verification (PSV) services for the alliance. Aperture performs the PSV once and shares the results with each participating plan that you authorize to receive it.
Additional details related to the Credentialing Alliance and some of the benefits you will see from it include:
- A single date that allows one recredentialing process to satisfy the recredentialing requirement for each of the participating plans with which you contract. That date is the earliest date you are set to be recredentialed by any of the participating plans. Following the initial alliance recredentialing event, your next recredentialing date will be set three (3) years out.
- For practitioner groups that are adding a new practitioner, you simply complete the common Practitioner Data Form once and send to each of the participating plans your group is contracted with. Practitioners must also make sure CAQH is updated and each of the participating plans that you are contracted with are approved to access your CAQH application.
- If you are a new practitioner, ancillary or facility, complete the appropriate common data form (Practitioner or Organizational), once and send to the participating plan(s) you wish to contract with. Facility/ancillary providers must also complete the common facility application.
- Practitioners who are registered with CAQH are encouraged to make sure CAQH is updated and each of the participating plans that you wish to contract with is approved to access your CAQH application.
- If you are not currently registered with CAQH our credentialing team will contact you upon receipt of your Practitioner Data Form and will provide you with a CAQH number and instructions on how to proceed with the next steps of credentialing.
- If you are a practitioner that requires a site visit as part of the initial credentialing event (Primary Care Provider or Obstetrician) or a facility that requires a site visit as part of the initial credentialing event (facilities that are not accredited or surveyed), the participating plan(s) that you are requesting to contract with will have access to any site visit already performed under the alliance. If a site visit has already been performed by another participating plan in the Credentialing Alliance, another site visit will not be necessary. If no site visit has been performed by a participating plan in the AzAHP credentialing alliance, a single site visit will be performed as part of the initial credentialing event and made available to all participating plans.
Health plans participating in the Credentialing Alliance and following the process outlined above include:
- Care1st Health Plan Arizona and WellCare Liberty (aka ONECare)
- Arizona Complete Health - Complete Care Plan
- Banner-University Family Care
- Comprehensive Medical and Dental Program (CMDP)
- Cenpatico Integrated Care
- Magellan Complete Care
- Mercy Care
- Steward Health Choice Arizona
- United Healthcare Community Plan
Next Steps
Please complete the applicable form(s) and fax the completed form(s) and attachments to our Network Management Team at 1-(602)-778-1875 or email them to sm_az_pno@care1staz.com
Practitioners:
Organizations (Facility/Ancillary)
Note: Each participating plan retains the right to make their own contracting decisions (whether or not to add practitioners and facilities to their network) and will make their own credentialing committee decisions (review of the primary source verification information obtained by OptumInsightTM resulting in approval/denial by the plan's committee).
If you have any questions please contact us at: 1-602-778-1800 or 1-866-560-4042 (options in order: 5, 7).
