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Providers

Credentialing/
Recredentialing

Two doctors sharing a laugh
Credentialing

We use the Council for Affordable Quality Healthcare (CAQH) system for credentialing and recredentialing our providers. Visit the CAQH website to register or log in to the CAQH Universal Provider Datasource to ensure that your application is up to date.

Provider organizations who are already contracted by Jefferson Health Plans and/or Health Partners Plans and need to have a new individual provider credentialed must submit a Provider Data Collection Form. We make every attempt to complete each application within 60 days of receipt of a complete application.

If you have questions about this process, please email our credentialing department at credentialing@jeffersonhealthplans.com.

Recredentialing

Individual providers are recredentialed within 36 months or less. Providers are notified four months prior to their recredentialing due date. To submit a recredentialing request, please complete a Provider Recredentialing form. To submit the form, or for any questions about the process, please email credentialing@jeffersonhealthplans.com.

Additional Credentialing Resources
Frequently Asked Questions

Provider groups that would like to link an actively participating provider should submit a linkage request via email on company letterhead to datavalidation@jeffersonhealthplans.com. Your signed linkage request letter on company letterhead must include the following:

  • Group name
  • Group NPI
  • Individual NPI 
  • Tax ID
  • Effective date of the linkage
  • Complete address (including phone/fax number)
  • Contact information

Participating provider groups that need to update their contact information (e.g., name, address, phone number, etc.) should submit the information change on company letterhead to  datavalidation@jeffersonhealthplans.com. A Jefferson Health Plans representative will contact you if additional information is required.

Providers should review their provider contract and review the contract termination requirements and ensure notification to Jefferson Health Plans meets requirements outlined in provider’s contract. Providers should submit termination notice to  datavalidation@jeffersonhealthplans.com  and  contracting@jeffersonhealthplans.com.

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