DHS Announces Efforts to Address Length of Credentialing Process for Medicaid Providers

On Sept. 30, 2015, the Pennsylvania Department of Human Services (DHS) announced that, beginning in 2016, it will impose additional requirements on its Physical Health Managed Care Organizations (PH-MCOs) related to credentialing timeframes.

The plans are now required to meet the following standards for timeliness of processing new provider applications for credentialing:

  • The PH-MCO must begin its credentialing process upon receipt of a provider’s application if the application contains all required information.
  • The PH-MCO may not delay processing the application if the provider does not have DHS-issued Medical Assistance identification (MAID) number. However, the PH-MCO cannot complete its process until the provider has received its MAID from DHS.
  • Provider applications submitted to the PH-MCO for credentialing must be completed within 60 days of receipt of the application packet if the information is complete.

DHS is interested in hearing from stakeholders who may have suggestions to streamline the process. Please feel free to forward your comments and suggestions to RA-PROVAPP@pa.gov.

The Pennsylvania Medical Society (PAMED) continues to work to improve this process for Pennsylvania physicians. In addition to being actively engaged with DHS, we’re also strongly supporting HB 1663 – a bill that aims to streamline the physician credentialing process and make it timelier and more uniform across all insurers in Pennsylvania. Contact your Representative and ask him/her to vote yes when this bill comes up for a vote.