How to Get Credentialed with The Health Plan Medicare Advantage in West Virginia
Quick Overview
Timeline
Varies
CAQH
Not Required
Re-credentialing
Every 3 year(s)
Delegated
No
West Virginia-Specific Requirements
Step-by-Step Enrollment Process
Gather Required Documents
Collect all necessary credentials including your medical license, DEA certificate, malpractice insurance, NPI number, and any state-specific requirements for West Virginia.
Prepare Your Application
Complete The Health Plan Medicare Advantage's provider enrollment application with all required information and supporting documentation.
Submit Your Application
Submit your completed enrollment package to The Health Plan Medicare Advantage.
Track & Follow Up
Credentialing typically takes 60-90 days. Monitor your application status and respond promptly to requests for additional information.
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Key Credentialing Terms
- CAQH
- The Council for Affordable Quality Health Care, an organization that maintains a universal provider database (CAQH ProVi...
- CMS-855
- The family of Medicare enrollment application forms used to enroll providers, suppliers, and organizations in the Medica...
- Credentialing
- The process of verifying a healthcare provider's qualifications, training, licensure, and professional background to ens...
- Effective Date
- The date on which a provider's enrollment or network participation becomes active, allowing them to begin billing a paye...
- MAC
- A Medicare Administrative Contractor is a private company that CMS contracts with to process Medicare claims and handle...
- NPI
- The National Provider Identifier is a unique 10-digit identification number issued by CMS to healthcare providers, requi...
- PECOS
- The Provider Enrollment, Chain, and Ownership System is the online portal used by healthcare providers to enroll in Medi...
- Primary Source Verification
- The process of verifying a provider's credentials directly from the original issuing source, such as medical schools, li...
Credentialing Checklist
Make sure you have everything ready before applying to The Health Plan Medicare Advantage.
View Physician Credentialing Checklist →Quick Links
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Our credentialing specialists verify every article against current CMS regulations, NCQA standards, and payer-specific enrollment requirements. See our editorial process.