Pennsylvania trying to shorten credentialing timeline

The Pennsylvania Department of Human Services is implementing steps this year to hopefully reduce the amount of time it takes providers to become enrolled in its state Medicaid program, Physical Health Managed Care Organizations (PH-MCO). Beginning in 2016, the managed care organizations have to meet the following standards for processing new provider applications:

• The PH-MCO must begin its credentialing process upon receipt of a provider’s application if the application contains all required information.
• The PH-MCO may not delay processing the application if the provider does not have Department of Human Services-issued Medical Assistance identification number. However, the PH-MCO cannot complete its process until the provider has received its Medical Assistance identification number from the Department of Human Services.
• Provider applications submitted to the PH-MCO for credentialing must be completed within 60 days of receipt of the application packet if the information is complete.

Source: Pennsylvania Medical Society