ChoiceHealth's delegated credentialing services follow NCQA, URAC, federal, and North Carolina Credentialing guidelines and laws. In order to assure compliance with North Carolina law, ChoiceHealth credentials the following types of providers: Optometrists, Podiatrists, Certified Clinical Social Workers, Certified Substance Abuse Professionals, Licensed Professional Counselors, Dentists, Chiropractors, Psychologists, Pharmacists, Certified Fee-based Practicing Pastoral Counselors, Advanced Practice Nurses, Physician Assistants, Occupational Therapists, Physical Therapists, Respiratory Therapists and Physicians.
Our credentialing processes include, but are not limited to, the following:
- Maintain current knowledge of and ensure compliance with NCQA standards and state and federal requirements
- Review application to ensure that it meets administrative requirements
- Ensure the application is complete within 15 days of receipt. Inform provider in writing of any deficiencies
- Obtain relevant documents (with the applicant's assistance, if necessary)
- Conduct primary source verification
- Prepare file for review
- Conduct site visits where applicable
- Complete credentialing process within 60 day time frame
- Inform provider of decision
- Inform managed care companies of decision
- Update credentials file at the time of re-credentialing
- Facilitate access to the appropriate provider numbers, if required
Our Credentialing Relationships
Delegated Credentialing
- AETNA Health of the Carolinas PPO, POS, EPO, HMO
- CCN PPO , Workers Compensation
- Cigna HMO, POS, PPO (Available to Novant-employed providers only)
- Coventry HMO,POS (Available to Novant-employed providers only)
- FirstHealth PPO, Workers Compensation
- GreatWest Healthcare HMO, POS, PPO
- Healthcare Savings PPO (Available to Novant-employed providers only)
- Humana PPO
- IPA of North Carolina HMO
- Kanawha Benefit Solutions PPO
- MedCost PPO (Available to Novant-employed providers only)
- Multiplan PPO
- Primary Physician Care PPO
- Private HealthCare Systems POS, PPO
- USA Managed Care Organization EPO, PPO
ChoiceHealth will perform traditional credentialing services for any "non-network" carrier for an additional fee.
For More Information
Contact our credentialing staff for details:
ChoiceHealth
1900 Randolph Rd., Suite 610
Charlotte, NC 28107
704-384-4975
ChoiceHealth
Frontis Plaza Blvd.
2085 Winston-Salem, NC 27103
336-277-1143 or 336-277-1065
