Credentialing

Upon receipt of a completed application, the application is reviewed and if the applicant has met the credentialing requirements a contract will be sent. The credentialing process may take up to four weeks.

Delegated Credentialing

PEHP may delegate credentialing activities to contracted provider groups that include at least three providers. The group must agree to follow PEHP credentialing requirements.

Recredentialing

PEHP requires that all providers falling within the scope of the PEHP program complete the recredentialing process at least once every three years. A verification form will be sent to the provider. All providers are expected to respond to the request in a timely manner. Proof of insurance including the limits must be sent with the verification form. All Providers must be recredentialed and approved for continued network participation.

PEHP Provider Relations Credentialing / Re-Credentialing Policy and Procedure