What We Do > Credentialing/Enrollment

Saint Francis Healthcare Partners (SFHCP) performs the essential function of credentialing on behalf of its members. SFHCP provides credentialing for practitioners with the following designations: MD, DO, DDS, DMD, DPM, PA, APRN, CNM and LMN.

Credentialing at SFHCP means less paperwork for practitioners and their office staff and one point of contact for SFHCP payors. SFHCP credentialing and recredentialing follows the standards of the National Committee for Quality Assurance (NCQA ). SFHCP has been approved by many of the payors to perform this function on their behalf through delegation agreements which speeds up the overall enrollment process

The recredentialing process is done at least triennially and this information is communicated regularly to the managed care plans. In 2009, SFHCP began utilizing the Council for Affordable Quality Healthcare (CAQH) online database to obtain the majority of provider information necessary to complete recredentialing; thus further eliminating requests for additional paperwork from the majority of our practitioners.

Additionally, SFHCP and Saint Francis Hospital and Medical Center Medical Staff Office share a common physician application. Active or Courtesy membership, whether with or without clinical privileges at Saint Francis Hospital and Medical Center are required for SFHCP membership.

Allied Health Practitioners must obtain privileges through the Medical Staff Office at Saint Francis Hospital and Medical Center if they will be render any patient care within the hospital setting.

Practitioners interested in joining SFHCP begin the credentialing process by contacting the Medical Staff Office at 860.714.4088 to request an application for hospital membership/privileges. Completed physician applications are returned to the Medical Staff Office, which in turn submits application copies to SFHCP for credentialing.

Another requirement for SFHCP physician membership is Board Certification. Physicians must obtain board certification in their practicing specialty within seven years of their last education and training or as determined by the specific board. Once obtained, board certification must be maintained to continue participation with the SFHCP.

Allied Health Practitioners must also be certified upon credentialing and must maintain their certification in order to continue participation with SFHCP.

Physicians must also contact SFHCP directly at 860.714.5755 for a SFHCP credentialing/enrollment packet. The packet includes the documents necessary for the insurance credentialing with SFHCP’s contracted payors.

Saint Francis Healthcare Partners also monitors and manages all aspects of practitioner enrollment to its contracted managed care plans including adds/changes/terminations, effective dates and provider numbers.

Contact Amy Mattex, Manager, Credentialing at 860.714.5755 for more information.

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