Payers Ease Credentialing During COVID-19
By Ellen Terry

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Commercial and government payers have temporarily eased credentialing requirements and procedures so more physicians can care for patients during the COVID-19 emergency. 

Below is an overview of some payers’ credentialing rules:

Blue Cross and Blue Shield of Texas (BCBSTX) follows a temporary credentialing policy. During the COVID-19 emergency, BCBSTX will:

  • Accept physicians licensed to practice in any state, and temporary licenses;
  • Accept expired documents if they have been inactive or expired for less than six months, and the physician is unable to obtain a current document from the issuer due to the COVID-19 emergency (licenses, accreditations, or certifications revoked for cause will not be accepted); and
  • Waive accreditation requirements, Centers for Medicare & Medicaid Services certification, and site visits for institutional providers.

Cigna has accelerated initial credentialing for COVID-19-related applications through June 30. Physicians are asked to identify their credentialing request as a COVID-19 application upon submission. Cigna will allow physicians already credentialed with Cigna to practice across state lines. See details in Cigna’s Provider Frequently Asked Questions for Coronavirus (COVID-19).

Humana is applying any federal or state credentialing emergency regulations for COVID-19 until the emergency regulations are lifted, such as:

  • Approving licensed physicians to practice outside their licensed state;
  • Placing a hold on decredentialing (only for physicians missing information); and
  • Waiving site visit requirements. 

Medicaid: Physicians not enrolled with Texas Medicaid or the Children With Special Health Care Needs Services Program can expedite enrollment by using the Public Health Emergency Enrollment Application. For information and instructions, see the April 1 document, Public Health Emergency Enrollment Application Now Available, from the Texas Medicaid & Healthcare Partnership.

Medicare: The Centers for Medicare & Medicaid Services (CMS) has established a toll-free hotline where physicians can enroll and receive temporary billing privileges. In Texas, the Novitas Solutions hotline number is (855) 247-8428 (7:30 am to 3 pm CT), and Novitas will attempt to screen and enroll the physician over the phone. This temporary enrollment will be deactivated 30 days after the lifting of the public health emergency declaration (with an option to complete a full enrollment during that window). CMS also is temporarily ceasing revalidation for all Medicare physicians during the public health emergency. Medicare-enrolled physicians may practice across state lines during the emergency period. For details, see these Medicare provider enrollment frequently asked questions

UnitedHealthcare (UHC) temporarily offers provisional credentialing to join its networks. Physicians who are already credentialed will not need additional credentialing to practice in a new location. UHC also is waiving site visit requirements. See UHC’s COVID-19 Credentialing Update page for information about recredentialing, provisional credentialing, and more. The information is applicable through June 18. 

You also can find the latest news, resources, and government guidance on the coronavirus outbreak by visiting TMA’s COVID-19 Resource Center regularly.

Last Updated On

May 05, 2020

Originally Published On

May 05, 2020

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