For Providers

Recredentialing Responsibilities

Recredentialing Responsibilities
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Compliance with Horizon NJ Health’s recredentialing standards is an ongoing contractual responsibility of all participating providers and other health care professionals. Participating providers and other health care professionals are also under a continuing contractual obligation to correct any previously provided credentialing information that is, or becomes, inaccurate.


As required by New Jersey state guidelines and accreditation bodies, all practitioners must be recredentialed every three years. Our recredentialing process begins approximately seven months prior to the recredentialing date. Providers and other health care professionals who fail to provide the necessary information in a timely manner will be terminated.


Medversant Technologies (Medversant), LLC, a leader in technology solutions for the management of health care provider information, is the authorized vendor that helps us carry out the recredentialing process.


Approximately seven months prior to your recredentialing due date, Medversant begins the recredentialing process by searching for current information on the Council for Affordable Quality Healthcare’s® (CAQH) online Universal Provider Datasource® (UPD).


  • If your information is up-to-date on the UPD, the recredentialing process will continue. If information is either not on the UPD or not updated on the UPD, Medversant will contact you by telephone, fax and mail to request updated and or missing information first by fax, then by telephone or mail. Please ensure all of your contact information is current and accurate.

  • If Medversant does not receive a response, Horizon NJ Health will mail two requests to your office. Horizon NJ Health’s first letter will be mailed 90 days before the recredentialing cycle ends. The final request will be sent via certified mail 60 days before the recredentialing cycle ends.

  • If Medversant still does not receive a response, you will be terminated from Horizon NJ Health and any other of the Horizon Blue Cross Blue Shield of New Jersey networks (if applicable) at the end of the recredentialing cycle.

We appreciate your continued participation and cooperation with Medversant and Horizon NJ Health, as we carry out our recredentialing process. If you have questions, please call Medversant at 1-800-508-5799 or your Professional Relations Representative.

 

How You Can Help

To keep the recredentialing process running smoothly, please confirm that:


  • All questions are answered.

  • All information and required source documents are current and included. For example, your proof of malpractice insurance - the item most frequently missing or expired, your federal Drug Enforcement Agency (DEA) certificate, your Controlled Dangerous Substance (CDS) certificate, etc.

  • Information on the application matches the information on your source documents.

  • Your Attestation has not expired.

 

Universal Provider Datasource

We encourage you to use CAQH’s online Universal Provider Datasource (UPD) to perform your recredentialing responsibilities. Visit www.caqh.org and click Universal Provider Datasource to access this valuable resource.


  • If you are registered with CAQH, review and or update your information and then reattest that your information is true, accurate and complete.

  • If you are not registered, click Logging in for the first time? Complete an online application and then attest that your information is true, accurate and complete.

  • To advise Medversant that your UPD information is updated, fax your first and last name along with your CAQH number to Medversant. Required source documents may also be faxed.

 

New Jersey Universal Recredentialing Application Form

If you are unable to use the UPD, please complete a copy of the New Jersey Universal Credentialing Application Form. This form is also available on the State of New Jersey Department of Insurance and Banking website at http://www.state.nj.us/dobi/division_insurance/managedcare/mccred.htm. If you do not have Internet access, you may request a copy of this form from Medversant by calling 1-800-508-5799.

 

Getting Information to Medversant

Recredentialing information and required source documents may be:

Emailed to Medversant at HorizonApp@medversant.com,

Faxed to Medversant at 1-877-303-4080 or

Mailed to Medversant at:

Medversant Technologies, LLC

355 South Grand Avenue, Suite 1700

Los Angeles, CA 90071