A request for an application from the Network Services department should be made as soon as a practice is apprised of the arrival of a new provider. Once the application has been requested, the application and contents are forwarded to the primary verification organization. PHP accepts the Council for Affordable Quality Healthcare (CAQH) credentialing application, Mid-Michigan Uniform Credentialing Application and the Michigan Association of Health Plans credentialing application.
When a provider completes a "clean" application, signs the contract and returns them both to PHP, the credentialing process begins.
- Signed attestation
- Identification and documentation explaining gaps in work history (if more than three months)
- Signed release of information
- Signed substitute Form W-9
- Collaborative Agreement between applicant and physician (for Advance Practice Nurses only)
- CLIA Certificate (if applicable)
- Documentation of medical education and training
- Copy of DEA (if applicable) and controlled substance license
- Copy of License
- Copy of Malpractice insurance including effective and expiration date, dollar amount, and name of the insurance company
- Identification of participating hospitals in which provider has clinical staff privileges and primary admitting facility
- Absence of or uncomplicated malpractice issues
- Explanation of any malpractice issues
On average, we expect this process to take sixty (60) days from the time an application is received to the approval by the Credentialing and Peer Review Committee, provided it is clean or complete. There are many steps that must be completed once we review your application.
We value your cooperation in this process. We are obligated to maintain our procedure with each applicant and our policy does not allow us to authorize services prior to approval at the Credentialing and Peer Review Committee. This is to assure the quality of the services we provide, as well as to fulfill our responsibility to our members.
Please note that applicants have the right to:
- review information submitted to support their credentialing application;
- correct erroneous information; and
- receive the status of their credentialing or recredentialing application, upon request.