Definition of Enrollment, Credentialing, and Contracting

Provider (Facility/Hospital)

Ancillary Services (Ambulance, Ambulatory Surgery Center, Clinic Facility, Dialysis, Durable Medical Equipment (DME), Home Health, Home Infusion, Hospice, Imaging/Radiology, Labs, Urgent Care), Hospitals (Critical Access Care, Behavioral Health (Community Mental Health Center (CMHC)), Long Term Acute Care, Long Term Care, Rehabilitation), Federally Qualified Health Center (FQHC), Rural Health Clinic (RHC), and Skilled Nursing Facilities.

Practitioner (Physician/Group)

A Medical or Behavioral Health practitioner participating in a group, RHC, or FQHC setting.

Enrollments

The process of loading a contracted and credentialed provider to all Managed Care Entity (MCE) internal systems, loading for claims payment, and loading to the provider directory (if applicable).

Credentialing

The process of reviewing the qualifications and appropriateness of a provider to join the health plan’s network. Credentialing requirements and processes will follow the National Committee for Quality Assurance (NCQA) guidelines.

Contracting

The process of the provider and Meridian formally executing an agreement for the provider to deliver medical services that outlines reimbursement rates, scopes of services, and so on.

Network Participation Request

A network participation request is when the provider makes a formal request to enter into a new agreement/contract with the Meridian. This includes the mechanism utilized by the Meridian to receive the request from the provider or group to join the Meridian network as a contracted provider. The network participation request must include all required information and attachments.

Network Participation Request documents required to enroll with Meridian as a Participating Provider and/or Practitioner

* Please note that all incomplete network participation requests will be rejected, and notification will be sent within 5 business days after the receipt of the initial request if the required documents are not provided.

Provider (Facility/Hospital)

The following specialty types require credentialing:

Ancillary Services (Ambulance, Ambulatory Surgery Center, Clinic Facility, Dialysis, DME, Home Health, Home Infusion, Hospice, Imaging/Radiology, Labs, Urgent Care), Hospitals (Critical Access Care, Behavioral Health (CMHC), Long Term Acute Care, Long Term Care, Rehabilitation), FQHC, RHC, and Skilled Nursing Facilities.

All other Providers (Facility/Hospital)
- IHCP MCE Hospital/Ancillary Provider Enrollment and Credentialing application
- Behavioral Health Facility and Ancillary Demographic Information (if applicable)
- Valid License (Rehabilitation facilities and labs are not issued licenses for Indiana. Certification for a rehabilitation facility is verified with the Indiana State Department of Health. The CLIA certificate is used in lieu of a state license for laboratories.)
- Accreditation certificate (if applicable)
- Copy of Medicare certification letter (if applicable)
- Copy of Medicaid certification letter (if applicable)
- Liability coverage face sheet (must not expire within 30 days of submission)
- Clinical Laboratory Improvement Amendments (CLIA) certificate (if applicable)
- Drug Enforcement Agency (DEA)# (if applicable)
- Provider Location Listing
- W-9 Form

Practitioner (Physician/Group)

The following specialty types require credentialing:

All Medical or Behavioral Health practitioners participating in a group, RHC, or FQHC setting. (Internal Medicine, Surgery, Pediatrics, Neurology, Family Medicine, Orthopaedics, Ophthalmology, Dermatology, OB/GYN, Urology, Physical Therapy, Psychiatry, Neurosurgery, Oncology, ENT, Nuclear Medicine, Cardiology, Cardiothoracic Surgery, Plastic Surgery, Preventative Healthcare, Gastroenterology, Intensive Care Medicine, Nephrology, Geriatrics, General Surgery, Rheumatology, Endocrinology, Allergy and Immunology, Hematology, Colorectal Surgery, Physical Medicine and Rehabilitation, Occupational Medicine, Pulmonary, Hematology/Oncology, Vascular Surgery, Medical Genetics, Osteopathy, Sleep Medicine, Sports Medicine, Immunology, Psychology, Nurse Practitioners, Mental Health Counselor, Family and Marriage Counselor, Addiction Counselor, License Social Workers, etc.)

All other Medical Practitioner taxonomies require the below forms:
- W9 Form

The following specialty types DO NOT require credentialing, or any forms listed above; however, you will need to fill out the required network participation request information through mimeridian.com.

Anesthesiology, CRNA, Diagnostic Radiology, ER Physician, Pathology, and Hospital-Based Practitioners. The following information is required:

Completed data form/Roster
W9 form

Meridian’s Credentialing Team Verification Criteria

Provider (Facility/Hospital)

The following specialty types require credentialing:

The following documents are required for credentialing as a Facility/Hospital:

Hospital/Ancillary Provider Enrollment and Credentialing Application
Behavioral Health Facility and Ancillary Demographic Information (if applicable)
Valid License (Rehabilitation facilities and labs are not issued licenses for Indiana. Certification for a rehabilitation facility is verified with the Indiana Department of Health. The CLIA certificate is used in lieu of a state license for laboratories.)
Accreditation certificate (if applicable)
Copy of Medicare certification letter (If applicable)
Copy of Medicaid certification letter (If applicable)
Liability coverage face sheet
Clinical Laboratory Improvement Amendments (CLIA) certificate (if applicable)
Drug Enforcement Agency (DEA) # (if applicable)
W-9 form

Practitioner (Physician/Group)

The following specialty types require credentialing:

The following specialty types DO NOT require credentialing:

Anesthesiology, CRNA, Diagnostic Radiology, ER Physician, Pathology, and Hospital-Based Practitioners

The following documents are required for credentialing as a Physician/Group:

Current and complete CAQH attested within the last 120 days
W9
Completed Practitioner agreement if brand new
ODF signed within 1 year if no practitioner agreement needed

The below information is required but is obtained from the IHCP MCE Practitioner Enrollment Form and the Current CAQH application:

Active Hospital Privileges or Admitting Arrangements (if applicable)
CLIA Certificate (if applicable)
Current State License
Current Board Certification (DO, MD, DPM only)
Current DEA/CSR License
Current Professional Liability Insurance
Education/Training
Sanctions History
Work History

If any information is expired or missing, Centene will request an updated version. Providers can respond via email, postal mail, or fax.

If the practitioner (Physician/Group) fails to respond by the 3^rd outreach or in the time stated on the notification, the request to enroll with Centene will be rejected and a letter and/or email will be provided.

Helpful Tips to Making Sure your Enrollments are Processed Successfully

Please ensure the following:

Your Provider (Facility/Hospital) and/or practitioner (Physician/Group) is enrolled with MDHHS CHAMPS system before the submission of enrollment or request to contract.
That all rendering practitioners associated with the group are tied to your group NPI and/or Tax Identification Number.
That all the required documents are up to date, complete, and accurate.
That your provider's (Facility/Hospital) and/or practitioner's (Physician/Group) taxonomy matches the enrollment form
The address the provider (Facility/Hospital) and/or practitioner (Physician/Group) is wanting to be added to matches the enrollment form
That the enrollment form is attached for all new enrollments.

In addition to the above:

Practitioner (Physician/Group)
If you are a practitioner (Physician/Group), please enroll as a Physician/Group. If you are an Ancillary or Hospital, please enroll as an Ancillary or Hospital.
If your practitioner (Physician/Group) is already enrolled under a location and you want to add an additional location with the same TIN and Group NPI, please select update on the Meridian Practitioner Enrollment Form and not new enrollment.
MCEs are encouraged to use the standard out of network process for services rendered by providers prior to the effective date if needed for member access to care.
The MCE network effective date must also be after the MDHHS CHAMPS effective date. Providers must be enrolled and effective with MDHHS CHAMPS prior to being effective with Meridian.
Notification from Meridian will be sent to the original submitter of an incomplete network participation request within five (5) business days after receipt of initial request. An incomplete network participation request is a request that Meridian cannot fully process because there is missing documentation, information needed to write a contract, etc.