MDs, DOs, DPMs or oral surgeons who do not participate in an IPA or PHO and are interested in contracting with Tufts Health Plan may be eligible to join Tufts Health Plan through an independent contract.
Step 1: Submit Credentialing Application
Providers must submit their credentialing application to CAQH ProView. CAQH applications in CAQH ProView with a status of Initial Profile Complete or Reattestation are available to move to the credentialing process. Any other status in CAQH ProView indicates an incomplete application and must be updated and reattested.
Include an explanation for any positive responses to questions regarding licensure and prescriptive practices, as well as the five-year work history section in month/year format.
Note: If the CAQH registration process has previously been completed, log in to update any information that has changed since the last attestation and authorize the release of data to Tufts Health Plan.
Step 2: Request to join the Tufts Health Plan Network(s)
Email a completed Provider Information Data Form (for Tufts Health Public Plans products) or the HCAS Provider Enrollment Form (for Commercial and Senior Products), and W9 to the applicable location:
Step 3: Contract and Credentialing Process
Tufts Health Plan reviews the application, generates a contract specific to the products intended to join and will email the contract to the primary method of contact. The contract should be reviewed, signed and sent back to Tufts Health Plan to initiate credentialing.
Tufts Health Plan’s Credentialing Department cannot process the application until all required materials are received including the HCAS Provider Enrollment Form and Provider Information Data Form. Providers will be notified by email if the application cannot be processed due to incomplete information.
Allow approximately 30 days for processing after the completed application and documents are received by Tufts Health Plan. Providers may check the application status during this time by sending an email to the applicable location:
Step 4: Approval Process
Once the application is approved, a welcome letter will be sent via email and will include the effective date for seeing Tufts Health Plan members, and additional useful resources, including claims submission information. For additional onboarding materials, refer to Welcome Materials.