Provider Credentialing

Provider Credentialing
provider.credentialing@hsc.utah.edu 
801-587-2838 Option 3

Practitioners

Providers must complete the provider contract application and approval process prior to credentialing with University of Utah Health Plans. 

As a member of the University Health Care team, UUHP strives to uphold the high standards of health care adopted by the University. The purpose of the UUHP Credentialing Program is to ensure that the UUHP provider networks consist of high quality providers who have met clearly defined standards. The credentialing program follows the standards set forth by the National Committee for Quality Assurance (NCQA).

In order to offer our providers an efficient credentialing process and minimize the time between contracting with UUHP and providing services to our members, our credentialing team has collaborated with NCQA, CredSimple, our NCQA certified Credentials Verification Organization (CVO), and CAQH Pro View, the trusted electronic solution and industry standard for universal credentialing applications.

To initiate credentialing for new providers with your practice, simply send the following information for each practitioner to be credentialed, or a roster containing the information below, to our credentialing team at provider.credentialing@hsc.utah.edu

  • Provider’s first and last names with middle initial
  • Provider’s title
  • Provider’s specialty
  • Provider’s date of birth
  • Provider’s CAQH Provider ID
  • Provider NPI
  • Primary Practice Location
  • Credentialing contact name and email address

(Example: John Q. Public – MD – Family Medicine – 01/01/1951 – CAQH 12345678 – NPI 1234567890 – Doctors Medical Clinic, 123 Main Street, Murray, UT 84117 – Mary Smith – mary.smithcredentialing@gmail.com)

If your provider has a completed CAQH application please ensure that UUHP has been granted permission to access the application, as well as confirm that the practitioner has recently attested to the accuracy and completeness of the information provided. If your provider does not already gave a CAQH application, the link to complete this one-time credentialing application used by multiple national healthcare organizations, at no cost to you, follows: http://www.caqh.org/sites/default/files/solutions/proview/guide/PR-QuickRef.pdf

The decision to accept or reject a practitioner’s application is based on information generated through primary source verifications of application information, complaints and grievances, malpractice history and board certifications. Other sources of information may be considered as appropriate and relevant at the sole discretion of the Credentialing Committee members. For unfavorable decisions, providers may consult the Practitioner Appeal Rights in the Credentialing Policy found on the UUHP website.

Initial credentialing and subsequent re-credentialing every three (3) years is required for all physicians and other types of health care professionals practicing under their own license as permitted by state law with whom members schedule appointments.

University of Utah Health Plans requires that Advanced Practice Professionals (APP), including PAs, complete credentialing. For Healthy U Medicaid, PAs will need to submit claims under the supervising physician as this is a requirement of State Medicaid. All other APPs will need to submit claims under their own name and NPI for both commercial plans and Healthy U Medicaid.

Monitoring of Provider Sanctions and Disciplinary Actions

UUHP does on-going monitoring of provider sanctions and disciplinary actions. Reports from the Health & Human Services (HHS), Office of Inspector General (OIG), System for Award Management (SAM), and the Department of Professional Licensing (DOPL) are reviewed monthly. Providers with Medicare / Medicaid sanctions, or who have a business relationship with another provider or entity that has been debarred or excluded, will be terminated from the UUHP participating networks. Providers who have had restrictions placed upon their license to practice will be presented to the Credentialing Committee for a decision on the appropriate action to be taken.

Practitioner Rights

  • The applicant shall have the right to be informed of their application status (Ready for Committee, App In-process, App Incomplete or Missing Information) upon request. The request shall be made via email to: provider.credentialing@hsc.utah.edu, or by phone to 801-587-2838, opt 3. Information on Practitioner Rights can be found in the Provider Manual on our website: www.uhealthplan@hsc.utah.edu . Emails will be responded to within 24 hours, and voice mails returned within 48 hours.
  • The Practitioner will have the opportunity to correct any erroneous information, as applicable, during the 2-3 month credentialing process. Applicants are notified of this right through our Provider Manual and website: www.uhealthplan@hsc.utah.edu
  • Erroneous information must be lined through with black ink, corrections above or to the side and initialed. No white out will be accepted. Corrections will be communicated to our CVO within 2 business days. Corrections can be submitted to: provider.credentialing@hsc.utah.edu
  • Upon request, applicants may review the information s/he has submitted in support of their credentialing or re-credentialing application, including but not limited to:
    • information from outside sources
    • malpractice insurance carrier face sheet
    • state licensing board
    • DEA agency verification
    • education verification letter from a school
    • board certification verification, if applicable
  • UUHP is not required to reveal sources of information that are not part of our verification requirements or if federal or state law prohibits us, such as NPDB reports. The applicant may view their file in the presence of the UUHP Medical Director and a member of the credentialing team. Applicants are notified of these rights in the Provider Manual and Credentialing Policy.

Organizational & Supply Providers

UUHP ensures that all organizational and supply providers have met their respective certifications, have current State licenses, are in good standing with state and federal authorities, and have adequate liability coverage. Credentialing is completed upon initial contracting and then every three (3) years.

  • Birthing centers must have a clear, written plan of transfer and transition of care in emergency circumstances. The plan must include the name(s) of the Hospital and the OB/GYN practitioner(s) providing backup.

To download the Organizational Provider Credentialing Application, please click on the link below.

Download Organizational Provider Credentialing Application

 

Organizational & Supply Providers

UUHP ensures that all organizational and supply providers have met their respective certifications, have current State licenses, are in good standing with state and federal authorities, and have adequate liability coverage. Credentialing is completed upon initial contracting and then every three (3) years.

  • Birthing centers must have a clear, written plan of transfer and transition of care in emergency circumstances. The plan must include the name(s) of the Hospital and the OB/GYN practitioner(s) providing backup.

To download the Organizational Provider Credentialing Application, please click on the link below.

Download Organizational Provider Credentialing Application

If you would like to submit a document for a Credentialing Audit, please complete the form and upload your documents.

Please note, your email address will only be used with this upload to work out any possible transmission problems. 
If you have a question about the file upload process, please call 801-587-6480, Option 2.

Provider Credentialing
provider.credentialing@hsc.utah.edu
801-587-2838 Option 3

 

Providers must complete the provider contract application and approval process prior to credentialing with University of Utah Health Plans.

The complete University of Utah Health Plans Credentialing Policy is located here.

If you have additional questions, please contact our credentialing team at:

Provider Credentialing
provider.credentialing@hsc.utah.edu
801-587-2838 Option 3

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Provider information in this directory is collected from information that we receive from our provider network and updated 5 days per week, excluding weekends, holidays, or interruptions due to upgrades, system maintenance, or unplanned outages. This information is subject to change at any time.