Providers - Credentialing

What is a Provider Agreement and Business Associate Agreement?

The Provider Agreement is AHC contract that needs to be signed by the provider. Please do not fill in the effective date, as that date will be when the Board meets and agrees accept your Credentialing/Re-Credentialing application.

When do I need to Re-Credential?

Re-Credentialing for Chiropractors is every 3 years from the anniversary date of starting with AHC. You will be notified in writing about 3-6 months prior to your anniversary date, so we have ample time to get all the paperwork, verifications, and medical review and then present you to the AHC Credentialing Board for approval. This all needs to be done before your membership expires or you will need to start the Credentialing process at the beginning.

ActivHealthCare On-line Credentialing

In order to ease the credentialing process AHC has created an on-line credentialing center. We have taken the State Credentialing Application and have removed any questions that do not pertain to the Chiropractic profession. We have also removed the need to duplicate information in the forms, such as writing your name and address multiple times.

What documents are required to Credential?

1) Complete the online credentialing application. Go to ActivHealthCare.com and select Credentialing then your state and then select Create an Account – if you already have an account see Re-Credentialing.

2) W-9 - This form can be downloaded from Credentialing or Forms on AHC website. Please complete the W-9 with the information that the IRS has listed with the Tax ID number you will be filing your claims under. This may be your company name and TIN or it may be your individual name and your S.S. number.

Why Credential with ActivHealthCare?

ActivHealthCare is a delegated credentialing network which is contracted with multiple insurance Networks. By credentialing with AHC, you will have access to various networks through a single source. Some of our clients do not accept providers unless they are credentialed by AHC. In other cases, you may find the AHC fee schedule more favorable than what you can get through a direct contract with our Network Affiliates.

AHC is required to follow NCQA and URAC standards for credentialing providers. Each Provider is individually credentialed.

What is Credentialing?

An examination and review of the credentials of individuals meeting a set of educational or occupational criteria and therefore being licensed in their field. Strict credentialing is required by both hospital and managed care accreditation bodies. The process is conducted periodically because of the responsibility of the organization for any claims of malpractice by its staff. Credentialing is done on a 3 year cycle. Re-Credentialing must be completed before the 3rd year anniversary in order to stay compliant.

Am I required to submit a renewed license or insurance information between the Credentialing cycles?

ActivHealthCare will Primary Source your license, so there is no need to send a copy in annually.

AHC must have verification insurance is current. The simplest way to do this is as follows:

    Insurance – Add AHC as a certificate holder to your malpractice and liability insurance policies. The carrier will then automatically update AHC when your coverage changes or renews.

How long does the Credentialing/Re-Credentialing process take?

The Credentialing Board meets monthly. We request that all paperwork be to AHC by the 1st of the anniversary month. Once the completed paper work has been received by AHC, it takes 30 days to be credentialed and approved by the Credentialing Committee. Once approved, AHC will send you an acceptance letter and forward pertinent information to our network affiliates. It takes up to 90 days for the network affiliates to add you to the participation provider rosters of their contracted claims payors.