Behavioral Health Allied Health Providers
Overview of the Credentialing and Contracting Application Process
The information below outlines Tufts Health Plan's process for credentialing and contracting Allied Health (i.e.; independently licensed) behavioral health (BH) providers. This process does not apply to hospital-employed providers, physicians, or providers employed by a physician group or licensed clinic. For information on the contracting for those providers, click here. This information is intented to provide insight into the entirety of the contracting and credentialing processes, highlight expected timeframes and offer contact information for the Tufts Health Plan teams managing specific steps within the process.
Network participation is contigent upon the successful completion of the credentialing and contracting process. For applicants who submit a clean and complete application (i.e. an application with no adverse responses, no quality issues, or missing information), the credentialing and contracting process for allied health BH providers can take up to three months. Applicants whose applications are not clean and complete may experience a lengthier application process until all of the necessary information is provided. The network effective date is the approval date of the credentialing application or the effective date of the signed contract; whichever is later. Providers are notified once the approval process is complete. Incomplete or unreadable applications will extend the overall contracting timeframes.
To join the Tufts Health Plan provider network, providers must complete the following steps:
Step 1: Request to join Tufts Health Plan Network(s)
Email a completed Behavioral Health Provider Application (BHP Application) and/or a Behavioral Health Clinic Application (BHC Application) to Tufts_Health_Plan_Credentialing_Department@tufts-health.com. Note: Providers may also fax the application(s) to 617.972.9591.
Tufts Health Plan will notify the provider once the application is received. The notification provides information on ensuring the credentialing process is completed in a timely manner. Email AHCBehavioralHealth@tufts-health.com with any questions.
Within 21 days of receipt of the application, Tufts Health Plan will send the provider a contract via email for review and signature. The credentialing process will not begin until a signed and dated contract is received and accepted. The contract will not be counter-executed by Tufts Health Plan and returned to the provider until the credentialing process is completed as outlined in Step 2 below.
Step 2: Credentialing Process
Upon receipt of a properly executed contract the Health Plan credentialing process will begin.
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. 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.
Tufts Health Plan will review the credentialing application and required credentialing documentation. Clean and complete* credentialing applications will be processed by Tufts Health Plan’s Credentialing Department within 30-days of receipt. Email Tufts_Health_Plan_Credentialing_Department@tufts-health.com with any questions during this timeframe.
Step 3: Enrollment and Contract Execution
Tufts Health Plan receives daily notifications when providers have successfully completed the credentialing process and have been approved to join the Tufts Health Plan network(s). Within 30 days, Tufts Health Plan will send a fully executed contract to the provider, via email, communicating the in-plan effective date, welcome packet information and behavioral health-related provider resource links.
*DEFINITION OF A CLEAN AND COMPLETE CREDENTIALING APPLICATION:
A complete application shall include:
- An application that is signed and appropriately dated by the provider applicant (CAQH application)
- Complete and legible information (Completed CAQH application should meet this requirement)
- Explanations that are satisfactory to the health plan, to any affirmative answer
- A current CV with appropriate required dates in months and years (Accurate and complete education & work history info in CAQH should meet this requirement)
- A signed, currently dated Applicant’s Authorization to Release Information form (Part of CAQH application)
- If practitioner is to have a current federal DEA controlled substance certificate or state Controlled Substance Registration but is not available, a letter describing prescribing arrangements (s.a., DEA still has out of state address)
- Hospital letter or verification of hospital credentialing (or alternative pathways), as required
- A copy of current malpractice face sheet coverage statement indicating name of insurer, amounts and dates of coverage (Accurate and complete malpractice insurance section in CAQH application should meet this requirement)
- Documentation of board certification (or alternative pathways)
- Documentation of training (if not Board-certified)
- No affirmative responses on questions related to quality or clinical competence
- No modifications to Applicant’s Authorization to Release Information form
- No discrepancies between physician-provided information and information received from other sources
- Appropriate health plan participation agreement(s), if applicable
- W-9 (Can be sent to CAQH as part of scanned documents. This also can be sent with health plan participation agreement(s)