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Credentialing / Recredentialing

Credentialing

Once you as an individual provider, a provider group or a facility have completed the contracting process with Paramount, the credentialing process will begin.

In order for Paramount to initiate the credentialing process for a practitioner a current and complete CAQH (Council for Affordable Quality Healthcare) Provider Credentialing Application Form is required.  Paramount will download the application directly from CAQH; in order to do so we require the following information:

  • Provider’s full name including degree (MD, DO, LISW etc)
  • Individual NPI number
  • CAQH number
  • Contracted group name, if applicable
  • Provider’s effective date with contracted group
  • Member capacity for PCP providers (Advantage Only)
  • Provider Billing Only/Non-Credentialed Roster (Hospital Facility Based, Providers not to be published in directories, etc.)
  • Behavioral Health Initial Roster

If you currently do not have a CAQH Provider Credentialing Application Form you can self-register and complete one by visiting the CAQH website. 

Ancillary/Facility Credentialing

In order for Paramount to initiate the credentialing process for a facility, a Hospital and Ancillary Facility Application is required to be completed. If applicable, we will also need your Provider Billing Only/Non-Credentialed Roster or Behavioral Health Initial Roster.

Ancillary/facility providers include hospitals, urgent cares, skilled nursing facilities, FQHC’s, Community Behavioral Health Clinic, Alcohol and Drug Addiction clinics, home health providers, DME providers, ambulatory surgical centers etc.

Recredentialing

We recredential our participating providers every three years by specialty. You will be notified by us approximately six months prior to your recredentialing date of the need to complete the CAQH Provider Credentialing Application Form. In addition to reviewing all credentialing materials, we may review the following information, if applicable:

Our credentialing/recredentialing process meets, at a minimum, all applicable regulatory requirements and, as an optimal standard, is modeled after National Committee for Quality Assurance (NCQA) standards. Our credentialing process may take 60 to 90 days to complete. You will be notified within 21 days if your application is incomplete. Upon completion of the credentialing process you will receive notice of participation. Please review your Practitioner Rights and the Credentialing Process.  

If you have questions regarding our credentialing/recredentialing processes, please e-mail our Credentialing Staff.