Frequently Asked Questions - Providers - 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.

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.

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.

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.

Once you create an online credentialing account at the AHC website, you can re-credential every 3 years by updating this original application. This is for Credentialing purposes only. Do not use to update your information between credentialing cycles.

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.

The Business Associate Agreement or BAA is required by HIPAA, the Health Insurance Portability and Accountability Act. The primary focus of this agreement is to stress the importance of confidentiality as it pertains to Protected Health Information or PHI. The Business Associate Agreement is not referring to you having a business partner and has nothing to do with your business.

The providers needs to sign the last page but not fill in the effective date as that will be when the Board meets and agrees to accept your Credentialing/Re-Credentialing application.

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.

3) Release Authorization – this document is signing that everything that you stated on the online application is correct and accurate.

4) CMS Worksheet (Coventry) – this document is required by Coventry and should be completed with the proper information about your company name and shareholders.

5) Provider Agreement – this document is ActivHealthCare’s contract

6) Business Associate Agreement – this document is ActivHealthCare’s HIPAA agreement

7) Multiplan Opt In or Out – This document is required to select whether you wish to enter AHC contract with Multiplan or choose to Opt Out. AHC contract with Multiplan includes Auto at a 7% discount over the allowed amount on our Multiplan Fee schedule.

8) Auto Option (Coventry) – AHC contract with Coventry has the option of adding on Auto. If you wish to Add on Auto select yes. If not select no.

9) EFT (Electronic Funds Transfer) – This document is required to directly deposit checks from AHC to your back account.

10) Certificate of Malpractice Insurance – One page showing your Name, Coverage Amounts (minimum coverage is 1M/3M) and expiration date. Adding AHC as a certificate holder will prevent your office from having to update this annually.

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.

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.