Resources

What are the benefits of joining CHP?

How to join the network?

  • Providers
  • Facilities
  • Complete the Provider- Network Participation Request form and submit it on our website. Your request is reviewed and providers will be notified of the outcome. If approved, a credentialing application is sent to you for completion.
  • Best practice is to submit this request as soon as you know a new provider will be joining to ensure that credentialing is complete before they start work at your organization.

Annual Dues

  • MD - $250 per year
  • All other provider types - $100
  • Facilities - $500
  • If CHP annual dues are not paid, the provider group will be terminated from the CHP network
  • IF A PROVIDER IS NOT LISTED ON YOUR ANNUAL DUES INVOICE:
    • Confirm they were not recently added as new providers would not be included since their dues will be paid during the credentialing process
    • Confirm they are not practicing elsewhere. Annual dues are sent to the TIN whose primary practice location the provider is associated with. One provider will only be responsible for one payment, regardless of how many TIN’s they are credentialed with.
    • To avoid confusion, please do not adjust your invoice without speaking to CHP first

Once I submit my application, how long will the credentialing process take?

  • All Licenses, education, insurance coverage, references, and work history are verified and could take up to 60 - 90 days to complete
  • Once reviewed and accepted by the CHP Credentialing Committee, a credentialing effective date is given
  • You will receive an acknowledgement letter stating you have been approved for membership and given an effective date
  • Your demographics and profile information is sent to each payer your practice has contracted with. The payers use the CHP effective date. Providers are able to start seeing patients on this day but are encouraged to hold claims for 60 days or until the provider is appearing on the payer directory or confirmed their participation with the payer via customer service.
  • Please be advised that CHP does not handle Medicare or Medicaid enrollment. Your organization must complete these enrollments before the provider's CHP effective date. Failure to do so will result in the provider not being loaded for Medicaid MCOs or Medicare Advantage plans with the payers.

Maximus

  • CHI Health Partners does not have access to the state file. It is the provider’s responsibility to ensure all information on the state file is accurate and matches what is sent to CHP. If this information is not accurate and up to date, you may experience billing and credentialing issues with the Medicaid payers. 

If the provider you are adding is already a CHP member, full credentialing is not required. Complete the Provider- Network Participation Request form via our website and submit. 

  • We will handle this as a practice change and will just need details about the former and new practice, effective dates, and a copy of the malpractice insurance certificate covering them while working at your practice. It should show the provider's name, effective date, and amounts of coverage. 
  • Your demographics and profile information is sent to each payer your practice has contracted with. The payers use the CHP effective date. Providers are able to start seeing patients on this day but are encouraged to hold claims for 60 days or until the provider is appearing on the payer directory or confirmed their participation with the payer via customer service.
  • To add or terminate an existing practice location or provider information, complete the Provider Information Change Request via our website. This information is then sent to each payer your practice is contracted with. 

Provisional Providers

  • Most insurance payers do not allow credentialing for Provisional licenses. However, BCBS and the managed Medicaid plans do allow provisional licensure for providing services to members.
  • Please be sure to notify CHI Health Partners when a provider obtains their full licensure and you have updated Maximus and PECOS if applicable, so we can send them to any additional payers that you accept through CHI Health Partners.

Exhibit 1.1 Document: 

  • The Exhibit document outlines the payers a group participating in CHP can access.
  • Filling out the exhibit:
    • ONLY CHECK THE PAYERS YOU WANT TO ACCESS UNDER CHP, DO NOT SELECT PAYERS YOU ARE CURRENTLY ACCESSING ELSEWHERE.
    • If you check a payer that you are already accessing elsewhere, this can cause claim/payment issues.
    • If you are accessing a payer through another entity (direct or another PHO) and want to move a payer contract under your CHP agreement, please follow the termination process required by your current contract.
      • Once you know the termination date, provide this date to CHP. We will use this information to determine your effective date under your CHP agreement to ensure there is no lapse in coverage.
      • In addition, we will need an updated exhibit to document the change.
  • Updating your exhibit:
    • You are able to add/term a payer at any time, however, each contract does have different termination clauses and some will require at least a 60-day notice.

How do I stay up to date with what is happening within CHP?

  • Please reach out to Jessica Singer to be added to the CHP network provider newsletter. The newsletter is sent monthly via email. The newsletter contains important information regarding CHP updates and notifications, as well as the latest updates from the payer plans.

When are the professional/facility fee schedules updated and how do I get them?

  • CHP will announce once we have received all our 1/1 updates in the newsletter. These updates are usually not received until mid-late Q1.
  • The Payer Notices include the rate information that is needed to calculate the allowable charges for each CPT code.

I think I am being underpaid for my services, what do I do?

Please send Jessica Singer/Lisa Sauer the following information and they can escalate:

  • Payer
  • DOS
  • Claim #
  • CPT Code
  • Billed Amount
  • Allowed Amount
  • Expected Amount

I am receiving denials with payers I access through CHP, what do I do?

  • Ensure you are not in the ’60 day’ update window for a new provider or provider update
  • Check the provider directory for the provider
  • For Medicare or Medicaid payers, make sure that you have completed enrollment prior to the CHP Credentialing effective date
  • Reach out to the payer’s customer service line and inform them of the denial and the status of the provider on the directory. If they are unable to assist, please reach out to Jessica Singer/Lisa Sauer  with the below information and they will escalate:
    • Payer
    • Reference number from call
    • TIN
    • NPI
    • Specialty
    • Patient Name
    • Patient ID
    • Group #
    • DOB
    • DOS
    • Total Charges
    • Claim #
    • Summary of the issue and desired outcome

Who are my contacts within CHP?

 

Clinical Quality

Mayo Referral Form

Through a unique partnership, CHI Health Partners participating providers have an option to refer patients with highly complex medical conditions to Mayo Clinic via our prioritized referral program. Access the online Mayo Referral form.

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