Credentialing is the process of obtaining and reviewing documentation to determine participation status in a health plan. The documentation may include, but not be limited to, the applicant’s education, training, clinical privileges, experience, licensure, accreditation, certifications, professional liability insurance, malpractice history and professional competence. Generally, the terms credentialing and recredentialing include the review of the information and documentation collected, as well as verification that the information is accurate and complete.
Andros processes dental credentialing and recredentialing applications on behalf of Humana.
Humana encourages the use of the CAQH application. These electronic methods provide a fast and easy way to securely submit credentialing information to multiple plans and networks by entering information just once. Application data can be submitted online at any time. The simplified credentialing process reduces paperwork and saves time. It is provided at no cost to your practice.
To become credentialed for the first time, you will need a current and complete CAQH application and should include the following:
- All information is completed on the form or marked as “not applicable.”
- All prior and current practice locations should be included on the application.
- Identification numbers such as the provider’s Social Security number, National Provider Identifier (NPI), Drug Enforcement Agency (DEA) and professional license number.
- All questions answered, including any necessary explanation.
- Attestation, signature and date should be within 180 days.
- Highest degree of education in MM/YYYY format, and needs to include city and state.
- Digital (scanned) copies of your:
- Curriculum vitae or work history in a MM/YYYY format for the past 5 years, and any gaps greater than 6 months need to be explained.
- Malpractice insurance, and it must not expire within 60 days of your application and should include coverage period with aggregate and occurrence dollar amounts.
How Do I Become Credentialed?
Once you have completed the contracting process, please follow the below options for completing recruiting. For providers with a CAQH ID, visit , opens in new window and do the following:
- Create a username and password
- Create a user profile
- The system will ask if you have a CAQH ID. A “Yes” answer prompts you to enter your CAQH number.
- You will receive an email confirmation to re-attest in ProviderSource.
Humana encourages the use of electronic credentialing methods*; however, if you are unable to complete an electronic application, please work with your contracting representative on obtaining a paper application.
*Note: The following states require the use of , opens in new window:
- New Jersey
- New Mexico
- North Carolina
- Washington District of Columbia
- West Virginia