Wellpoint Provider Credentialing & Enrollment Guide

Wellpoint provider credentialing involves multiple steps and strict adherence to documentation and procedures. A single errorr in the Wellpoint credentialing can easily push applicants months back in revenue generation. The credentialing applies to Arizona, Iowa, New Jersey, Tennessee, Texas and Washington. Additionally, the ProView profile plays a vital role in this credentialing. Therefore, applicants must ensure the process is followed to the T and submit a complete application only.

Wellpoint is Elevance Health’s new name for its Medicaid, Medicare, and commercial products. The primary purpose is to consolidate several plans under a single name by removing the previous name (i.e., Amerigroup). It is applicable to states like Arizona, Iowa, New Jersey, Tennessee, Texas, and Washington. 

For healthcare providers seeking Wellpoint provider credentialing, there aren’t any daily activity changes. 

But the only difference is that anyone seeking Wellpoint credentialing must follow the new process rather than the old Amerigroup credentialing process.

A Step-by-Step Guide to Wellpoint Credentialing Application

Wellpoint credentialing relies on the CAQH ProView system as opposed to the proprietary version many payers use. The Wellpoint credentialing application process can seem complicated for first-time applicants, but it is not. 

Here is a step-by-step guide to credentialing with Wellpoint for providers:

1. Create Your CAQH Account

Providers who don’t already have an account can create one at CAQH ProView. The registration will involve your information. The information may include licensure, education, employment, and malpractice, and will be stored there and used by other payers as well as Wellpoint.

2. Grant Access to CAQH ProView Account

You may already be registered for other payers, but that does not mean Wellpoint has access. In order to grant Wellpoint access to your information, you’ll need to authorize it. Then, the process moves to the next step.

3. Send In-Network Participation Request

The in-network participation request requirements may be state-specific. For instance, in states such as Texas, applicants are required to send their Request for Credentialing/Letter of Interest form together.

Additionally, the request must also include the W-9 form to the appropriate regional credentialing mailbox. In other states, you only have to complete an online application found on their Wellpoint providers’ website.

4. Update the CAQH Attestation

Wellpoint then checks for a signed attestation and a proper application date on the request. The network will verify the CAQH status of “Initial Application Complete” or request a re-attestation (depending on the status). 

Applicants should always make sure that they have a valid attestation because an expired attestation is a leading cause of a stalled file even before review.

Wellpoint Provider Credentialing Requirements

Wellpoint provider credentialing applies to physicians who are licensed for independent practice. The providers should have an “independent relationship” with the plan (e.g., they should be listed as a selectable primary care provider).

It may also involve healthcare providers who are operating within Wellpoint and providing services to its beneficiaries. More importantly, credentialing may apply to individual practices, groups, telemedicine, rental networks, and some PPOs. 

However, for locum tenens billing for providers, there is a different requirement: 

Providers practicing for less than 60 consecutive calendar days will only have provisional credentialing. Conversely, those practicing 60 or more consecutive days require full credentialing.

The Wellpoint credentialing requirements you are likely to meet and get verified usually include:

• Credentialing details.
• Current unrestricted license in all states where you practice your profession.
• Education and training background, verified by the licensing board or primary source.
• Work experience for the past years with explanations for any gaps.
• Malpractice insurance coverage and history of claims.
• Board certification, when applicable.
• DEA registration or state controlled substance certificate (in case you prescribe scheduled medications).
• National Provider Identifier (NPI).
• Nurse Practitioner or Physician Assistant must submit active certification by the appropriate national organization.

The Wellpoint credentialing verification period for primary sources should be no older than 120 days. The duration counts from the Credentials Committee’s vote, while the attestation form, with work history, must not be older than 180 days from the vote. 

Note that the above-mentioned deadlines are critical to the Wellpoint credentialing process. If a provider submits an accurate but outdated verification, Wellpoint may demand re-verification.

We also recommend tracking the Wellpoint credentialing application status to identify hiccups during the process.

Challenges in Getting Credentialed with Wellpoint

Getting credentialed with Wellpoint involves bypassing few recurring problems, which may include:

1. The most prevalent issue in Wellpoint credentialing seems to be an outdated CAQH profile. This generally occurs because the profile attestations only last 120 days. In addition, an outdated or invalid attestation cannot be used to review a file. 
2. Any gaps in work history that cannot be explained will also pop up again and again. This generally happens because the verification standards require a clear timeline rather than just estimated time periods.
3. State-specific changes or rules also pose a challenge. For instance, some states utilize a third-party verification service in addition to Wellpoint’s own department. Texas uses Aperture, LLC, which can alter the overall credentialing process.
4. Providers who do not consider varying requirements sometimes send their documents to the wrong place altogether, which stalls credentialing.
5. Primary source validation depends on feedback from other parties to the inquiries. This implies that delays from the licensing board or a previous employer disrupt the application process.

Wellpoint provider credentialing can either be a simple process or a headache, depending on how well your in-house team manages the posed challenges.

Best Practices for Wellpoint Insurance Credentialing

Wellpoint credentialing challenges can prolong the overall process or even stall it completely. Fortunately, the right practices can prevent healthcare providers and facilities from facing such situations. Here’s what you can do:

1. Maintain an updated CAQH account even before receiving expiration notifications from CAQH. This will help applicants avoid the possibility of the payers extracting outdated data. 
2. Ensure licenses you provide are valid in all the states in which you practice. Even one lapse may affect your entire application.
3. Record your employment history right away rather than recreating it later on demand. It is important to know what regional procedure you will have to follow before you begin. This can help you handle Wellpoint’s procedure state-specific requirements.
4. Following up periodically after submission of your information allows you to respond to any corrections needed within 14 days.

These suggestions might seem basic at first but can ensure your Wellpoint credentialing forms are submitted on time and accepted without delays.

Wrapping It Up

The Wellpoint provider credentialing process was designed comprehensively, and that factor alone often creates issues for providers seeking to credential and join the network. A forgotten attestation or a missing time period can put your request on hold. Even a form going to the wrong email address can add weeks to the already extensive process. 

Providers who prefer not to deal with Wellpoint credentialing on their own can seek assistance from several professional services. For example, MediBillMD’s insurance credentialing services handle Wellpoint credentialing and enrollment without a problem.