HealthCare News

Recredentialing Application Timelines Change

Issue: #390 SEP2016

Topic: Education

Providers may start to notice a change in the recredentialing application formats as well as the timelines for these requests.

In recent years, when a provider (professional, facility, or institution) was nearing the three-year recredentialing due date, an application was mailed at least 180 days prior to that due date (with second and third requests sent when no response was received). However, the applications needed to be re-formatted, and it was decided that recredentialing requests were being mailed out too early, causing them to be misplaced or forgotten by the time they were due.

By the end of 2016, an initial request for recredentialing will be mailed 90 days prior to the provider’s recredentialing due date. If no response is received within 30 days, a second (and final) request will be sent.

The letter attached to this final request will include the exact due date by which recredentialing must be processed, or the provider will be changed to a “Nonparticipating” status, which will be deemed a “voluntary” termination of contract due to lack of response to cecredentialing efforts. This means reimbursement will go to members at a possible reduction for services provided by a Nonparticipating provider, and the provider will not be eligible to reapply for participating status for a period of one year.

This change is occurring to allow for tighter recredentialing timelines in order to remain in compliance with URAC standards for credentialing and recredentialing.