Upcoming Changes to Credentialing and Provider Directory Management

 

EmblemHealth is introducing new enhancements to streamline the non-delegated credentialing and recredentialing processes for healthcare professionals. These changes aim to reduce administrative burdens and improve the accuracy of provider directory listings.

Simplified Initial Credentialing

To ensure a more efficient credentialing process, EmblemHealth will continue requiring a Council for Affordable Quality Healthcare (CAQH) ID for all first-time applicants. Applications submitted without a CAQH ID will not be processed. Providers should ensure their CAQH profiles are up to date before applying.

Enhanced Recredentialing Process

EmblemHealth is expanding its partnership with CAQH to include recredentialing. Provider data will now be imported directly from CAQH, reducing the need for redundant paperwork and simplifying the process for healthcare professionals. This update will help providers maintain their credentialing status with fewer administrative steps.

Quarterly Provider Directory Validation

To maintain up-to-date provider directories, EmblemHealth will now conduct quarterly directory validation audits in collaboration with CAQH. As part of this process, CAQH may contact provider offices to confirm directory accuracy and network participation. Providers are encouraged to inform their staff about these outreach efforts and ensure their information remains current.

 

These updates are designed to improve efficiency and accuracy while minimizing administrative work for providers. To stay informed and ensure a smooth transition, providers should regularly update their CAQH profiles and review communication from EmblemHealth.

For more details on managing provider data changes, visit the EmblemHealth | ConnectiCare website.

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