Credentialing

Credentialing providers for a Medicare Advantage plan involves verifying their qualifications, licenses, and professional background to ensure they meet the necessary standards for delivering quality healthcare to plan members. This process ensures that providers are qualified and compliant with regulatory requirements.

It is crucial to initiate the credentialing process for Arizona Priority Care (AZPC) as soon as a new provider joins your group to avoid any delays in payments or service authorizations. To learn more about AZPC’s Credentialing Plan, please click here.

You can also find the credentialing checklist of all materials needing to be submitted for credentialing listed here.

Credentialing Process:

1. Submission and Review:
   • Once an acceptable Provider Participation Request form is submitted, our Network Contracting team reviews the documentation before forwarding it to the Credentialing Department for processing.
2. Primary Source Verification:
   • A Credentialing Coordinator conducts primary source verification and will contact you to request an Information Release Form to complete the application.
3. Credentialing Committee Approval:
   • After all required documentation is collected, the application will be reviewed by the Credentialing Committee for approval.
4. Provider Directory Update:
   • Once credentialing is complete, Network Contracting will add the provider to the directory and notify you by mail with the provider’s effective date.

Re-Credentialing:

Arizona Priority Care adheres to NCQA standards, which require re-credentialing at least every 36 months.

Required Documentation:

To help streamline this process, please ensure the following information is available and up to date:

• Current copy of Malpractice Insurance and Medicare Letter.
• Signed and dated AZPC Information Release Acknowledgement form (handwritten signature required).
• CAQH Application with a current attestation date of 120 days or less.
• Name and address of your primary admitting hospital or current admitting arrangements.
• Completed narrative of malpractice claims, medical license actions, privilege suspensions, etc. (if applicable).

Provider Resources

Provider Services Phone
(480) 499-8720
(855) 706-8388

Downloads
AZPC Credentialing Plan – 2024
AZPC Facility Application
CAQH Provider Data Portal