Credentialing requirements
Providers MUST NOT render services to CHA members until the credentialing process has been finalized and have been given an effective date unless otherwise written for approval.
To contract with CHOC Health Alliance, you must:
- Have an NPI number
- Have an active registration with Medi-Cal
- Be board certified, or actively pursuing board certification. (Physicians licensed before January 1, 2008, are exempt from this requirement.)
Who must be credentialed?
- Physicians
- Mid-level practitioners
- Allied health professionals
Initial and re-credentialing required documents include:
- Curriculum vitae
- Current medical license/professional license
- Drug Enforcement Administration license (if applicable)
- Certificate of professional liability insurance
- Mid-Level clinician agreement (for nurse practitioners and physician’s assistants only)
If you have credentialing questions, contact the CHA credentialing analyst at (800)387-1103.
Notification of changes within your practice, group, or facility
If you make changes within your practice, CHOC Health Alliance (CHA) requires 90 days prior notification. All changes may be faxed or mailed to Provider Services. If a primary care provider reports changes, we are required to notify our affected members within 30 days.
For the following changes:
- Name
- Phone and/or fax numbers
- Location and/or address
- Additions, terminations, deletion of services
You must submit
- provide written notification on letterhead of change, including the effective date. If terminating, include where members should be moved. If no provider is designated; CHA will move members accordingly.
If you make changes to business ownership and/or changes in tax identification number you must submit the following documentation and forms:
- Written notice on letterhead of changes, including the effective date
- W-9
About Electronic Health Records (EHRs)
Over the past several years, many physicians have been implementing EHR systems. With the Affordable Care Act, even more offices are following suit. EHR systems help improve the efficiency of communication with patients. It can lead to cost savings for many physicians making the switch to EHR, communicating real time results to members in a seamless flow of information within a growing digital health care infrastructure. Information is made available whenever and wherever it is needed.
Benefits of EHRs:
- More complete patient record
- Increased accuracy of patient diagnoses
- Improved ability to make treatment decisions quickly and safely
- Better coordination of care
- Increased efficiencies
- Greater cost savings
- Enhanced ability to engage a patient in his/her own care
If you use an EHR system, you may be eligible for Meaningful Use financial incentives from the Centers for Medicare and Medicaid Services.
