New Vendor Certify Adds Efficiency to Credentialing Process
Starting March 1, 2025, Premera began transitioning to electronic applications for credentialing and re-credentialing through the Council for Affordable Quality Healthcare (CAQH). Part of this transition includes working with new vendor Certify to handle the intake of initial credentialing applications, credentialing verifications, and ongoing monitoring. Certify came on board in March 2025.
Certify is acknowledged by the National Committee for Quality Assurance (NCQA) as a credentialing verification organization. They may contact you on our behalf if more information is needed during the credentialing process. This new collaboration will make the credentialing process much faster and less of an administrative burden for providers.
Faster processing time, reply within 7 days if more info is needed
There are three items to note as part of this change in our credentialing process:
- Starting in May, providers will no longer need to send a completion email to Premera.
- Fast processing in as little as 10 days.
- If additional information is needed, Certify will reach out through email and will require a response within 7 days to avoid having to re-apply.
How is credentialing different from contracting?
Credentialing is a background check of healthcare providers. Information is verified through a detailed application process by Premera in accordance with NCQA standards. A provider must be credentialed before requesting a contract. Contracting is when a provider signs a contract to join a health plan’s network.
A few key credentialing items to remember:
- You must complete re-credentialing every 3 years to avoid contract cancellation.
- Completing credentialing doesn’t mean you’re officially contracted with Premera and able to see patients.
- When you receive your fully executed contract (through DocuSign) you’ll have a copy of your contract and your official effective date.
How to get ready for the credentialing changes
- Look for CAQH information on the Premera Join Our Network web page.
- Make sure you have a current account with CAQH. If you’re not sure, call 888-599-1771 to avoid creating a duplicate account. If you do have a CAQH account, attest to your credentialing information (if beyond 120 days) by signing in to CAQH.
- Register with CAQH if you don’t have an account. Go to the bottom of the page and select “If you are a first-time user, register here.”
- Identify Premera as a health plan that can access your application or indicate global authorization. If access isn’t granted through CAQH, we can’t retrieve and process your application.
CAQH training resources
For training resources, visit the CAQH training portal. Registration is required to access training resources.
CAQH Solution Center, 888-599-1771, Monday through Friday, 8 a.m. to 8 p.m. (ET)
We appreciate your patience as we make this important transition. Stay tuned for more updates in Provider News.