Providers who wish to contract with CareSource® must first be credentialed. Through credentialing, we check the qualifications and performance of physicians and other health care practitioners. Providers are recredentialed a minimum of every three years and are considered to be recredentialed unless otherwise notified.
Contracting and Recredentialing Process
CareSource credentials providers using guidelines from the Centers for Medicare and Medicaid Services and the National Committee for Quality Assurance (NCQA) and as defined by West Virginia Code and the West Virginia Department of Insurance.Our Vice President/Senior Medical Director is responsible for the credentialing and recredentialing program.
West Virginia Health Coverage Programs and CareSource require that you submit your National Provider Identifier (NPI) number to CareSource along withthe completed West Virginia uniform credentialing and recredentialing form.Also complete the Council for Affordable Quality Healthcare (CAQH) application or submit your CAQH number and National Provider Identifier (NPI) number to CareSource.
CareSource is a participating organization with CAQH. Please make sure that we have access to your provider application before you submit your CAQH number as referenced above:
- Log on to CAQH using your account information.
- Select the Authorization tab.
- Make sure CareSource Marketplace West Virginia is listed as an authorized health plan.
- If not, check the Authorized box to add.
Please also include the following documents:
- Drug Enforcement Administration (DEA) certificate
- Malpractice insurance face sheet
- Clinical Laboratory Improvement Awards (CLIA) certificate, if applicable
- Standard Care Agreement (SCA), if an advanced practice nurse
- Supervisory agreement, if a physician assistant
It is essential that all documents are complete and current, or CareSource will discontinue the contracting and credentialing process.
If you have missing or expired documents, the Credentialing staff will send you a letter with instructions to correct and submit the updated information.
For questions about credentialing, call CareSource at 1-855-202-1091 and follow the prompts to be directed to one of our Credentialing staff. You can leave a detailed message, and one of our staff will return your call within threebusiness days. We can research the status of yourapplication in the credentialing process or what documents might still be needed.
Or, you can find more information about credentialing in our Provider Portal