CREDENTIALING AND APPOINTMENTS/ REAPPOINTMENTS
Selection Phase
There are a multitude of insurance companies or EAPs that you may want to be networked with. Major companies include: Aetna, Anthem, Cigna, Humana, Magellan, Medicaid, Medicare, Optum, Tricare, United Healthcare. Our expert team can help you in your selection of panels you would like to participate in.
Complete Peregrine’s comprehensive checklist and send in necessary documentation as indicated.
Review your CAQH profile for accuracy. Peregrine changes credentialing contact to Peregrine and adds Peregrine E-mail to provider’s profile to ensure receipt of reattestation deadline notices. Peregrine takes care of the attestations every time they are
needed.
Application Phase
Peregrine will begin new applications, re-credentialing requests or negotiation appointment applications, etc. We report any “closed” panels to you, and per your request submit an appeal on your behalf.
Follow Up Phase
We will follow up with the various insurance companies and facilities to ensure they have everything required to process your application.
Please note we cannot expedite the processes that the Health Plans or facilities have internally.
Contracting Phase
Once a contract is received from an insurance company or EAP, we will review them for accuracy before forwarding them to you or your office for review, approval and signature.
Negotiation of rates or terms will be done on your behalf after we discuss with you and obtain your feedback.
Confirmation Phase
We submit signed contracts on your behalf.
We track, and follow up as necessary, to ensure we receive confirmation of your enrollment and all plans are “loaded” properly at the health plan.
Maintenance Phase
We maintain the credentialing files and provide client reminders when certifications or licensures are going to expire.
Note: Throughout the Credentialing process you will have complete access to see all managed care organization agreements as well as all
correspondences as amendments by accessing your account via our secure server.
