Physician and Facility Credentialing

Humana participates with the Council for Affordable Quality Healthcare (CAQH) Universal Credentialing DataSource initiative, an online service to help physicians and other health care providers more easily and cost-effectively provide required credentialing information to health care organizations and health plans.

Universal Credentialing DataSource

Humana network and ChoiceCare Network physicians and other health care providers can now utilize CAQH’s Universal Credentialing DataSource for recredentialing, instead of completing a Humana-specific credentialing application. New physicians and other health care providers joining the network will also be able to use CAQH for the initial credentialing process.

This option offers several benefits to physicians and other health care providers. Universal Credentialing DataSource provides a fast and easy way for physicians and other health care providers to securely submit their credentialing information to multiple health plans and networks by entering their information just one time. Application data can be submitted anytime through the convenience of the Internet or by fax.

This simplifies the credentialing effort, reduces paperwork and saves time for busy physicians and other health care providers and their office staff members. Best of all, this service is provided at no cost to participating providers.

How it works

Humana issues a unique CAQH identification number to each provider who wants to be a part of CAQH. Once in the system, the provider creates a user name and confidential password. With this user name and confidential password, the provider can begin to complete the application online.

The process incorporates the Standard Application Data Set and also, where appropriate, accounts for any additional credentialing information required by states with specific application mandates. Before the completed application is available to any participating organization, the provider must authorize release of the data. Each organization that has included the provider on its roster will appear on the authorization screen for the provider to review and authorize.

The applications are stored in an online database and are always available to the provider to update, review or print. The applications are also available to participating and authorized health plans to view, search and retrieve credentialing information regarding providers in their networks.

Once a provider completes the process, automatic reminders are sent each quarter to prompt a review and update of the information. It is the provider’s responsibility to maintain accurate and complete information. Updates can be entered at any time.

If you are not currently a participating provider and considering joining the Humana/ChoiceCare Network, please contact our Provider Relations Representatives at (800) 626-2741 or via email at CHCPR@humana.com for required contracting and credentialing information.

Participating Humana network providers and ChoiceCare Network providers who do not already have a CAQH ID and wish to participate with CAQH may contact Cyndie Rees, Credentialing Specialist, at crees@humana.com, or mail a written request to the following address:

Humana
101 E. Main St., 7th Floor
Louisville, KY 40202
Attn: Cyndie Rees

In order to process the nomination, the following information is required:

Provider’s full name
Date of birth
Unique provider identification number (UPIN)
Specialty
Office complete address
Office phone number

Upon receipt of all required information, the unique CAQH number will be issued to the provider. CAQH will also mail a Welcome Packet including the CAQH application to the provider.

If you have any questions, contact Cyndie Rees, Credentialing Specialist, at crees@humana.com, or by calling (502) 476-6479.

For more information about CAQH, see CAQH Website:CAQH .