Physician Credentialing




Physician credentialing—the process of evaluating the qualifications and practice history of a physician—can sometimes take as long as six months, sidelining and frustrating physicians, and creating barriers to patient care.

As part of its Healthy Doctors, Healthier Patients initiative, the WSMA successfully advocated in 2016 for legislation (House Bill 2335) that, for the first time in our state’s history, streamlines and standardizes applications and limits the turnaround time for insurers to approve or deny those requests.

As a result, starting June 1, 2018:

  • Insurers must credential physicians and other providers within 90 days (and an average of 60 days, beginning in 2020).
  • Insurers, physicians and other providers must use ProviderSource to submit and process credentialing applications.

Background

Two major problems exist with insurers’ credentialing systems, both stemming from a lack of standardization. First, each insurer has a unique process that requires some, but not all, of the same information from physicians. A physician contracting with 15 insurers in our state must complete each company’s respective credentialing process—a time-consuming endeavor. Second, it may take months for an insurance carrier to approve an application, preventing physicians from providing care to their patients in those networks—and earning an income—for a good portion of a year.

The process

Starting in June, you must submit applications to insurance carriers via ProviderSource, a free health care credentialing tool operated by OneHealthPort, the state's lead organization providing health information techonology. ProviderSource will allow you to build a comprehensive professional profile, which also functions as a secure, universal credentialing and enrollment application. Once submitted, insurance carriers will have 90 days to approve your application. Note that 90 days is the ceiling; as all parties are required to use ProviderSource, we anticipate a reduction in the back-and-forth that tends to slow this process down, resulting in faster turnaround times.

Getting started

To prepare for the June 1 implementation date, visit OneHealthPort's credentialing webpages for step-by-step instructions for setting up your profile before logging into ProviderSource. Be sure to review the training videos and guides also provided by OneHealthPort to make sure you understand how to use all of the ProviderSource features.

WSMA resources in development

The WSMA has been working with the Association of Washington Health Plans and OneHealthPort (the entity that operates ProviderSource) to optimize the system before the June implementation date. Check back on this page and in future WSMA communications for further information and resources to help you make the most of these new requirements.