Provisional Credentialing

AmeriHealth Caritas Louisiana (ACLA) acknowledges the impact of the current COVID-19 pandemic on the ability of providers to obtain needed documentation for the credentialing and enrollment process.

As such, and in line with Louisiana Department of Health (LDH) policy waiver, ACLA has developed the below contingency plan to address provisional credentialing effective March 23, 2020. This temporary waiver applies to new Physical Health & Licensed Mental Health (LMHP) Practitioners who have never been credentialed with ACLA and providers participating as part of an emergency response team.

Due to the COVID-19 pandemic, ACLA has updated its policy to align with NCQA to allow for Provisional Credentialing for a period of up to 180 days.

The following documents are required to provisionally credential: 

  • A current CAQH application or a current, complete, and signed application with attestation;
  • Current, valid, unrestricted license;
  • Current malpractice insurance with limits of liability commensurate with State requirements; and,
  • Confirmation of the past five (5) years of malpractice claims and settlements from malpractice carrier or NPDB results 

New providers seeking provisional credentialing and who seek to be part of the ACLA provider network beyond the COVID-19 pandemic should submit the required documents to ProviderEnrollment@amerihealthcaritasla.com. 

Upon the receipt of the above documents, ACLA will load the provider into its provider and claim processing system effective with the date of receipt. 

All documents will be required within 180 days as the practitioner must go through the full initial credentialing process within 180 days of provisional approval or when there is no longer a state of emergency. 

Providers participating as part of emergency response team(s). Practitioners who do not seek to be part of the ACLA provider network/practice following the COVID-19 pandemic, and are providing care to members/patients as part of federal, state or local government emergency response team should submit a non-participating provider form (PDF) to network@amerihealthcaritasla.com.

Upon the receipt of the document, ACLA will load the provider into its provider and claim processing system effective with the date of receipt, and will remain effective until November 1, 2020.

Organizational Providers (Facilities/Hospitals)

Organizational Providers will continue to be evaluated for network adequacy and Provisional Credentialing will be extended for those applications in need of a site visit (no accreditation or CMS State Survey), when a site visit cannot be scheduled.

Provisional Credentialing is valid for a period of up to 180 days, at which time full credentialing is required.

The following documents are required to provisionally credential:

  • A current, complete, and signed application with attestation;
  • Current, valid, unrestricted license;
  • Current malpractice insurance with limits of liability commensurate with State requirements;
  • Confirmation of the past five (5) years of malpractice claims and settlements from malpractice carrier or NPDB results;
  • Active Medicaid Number/Enrollment/Certification, if applicable; and,

Upon the receipt of all of the above documents, ACLA will load provider into its provider and claim processing system effective with the date of receipt.

New Group Affiliation/Linkage

Applies to existing/credentialed Physical Health & Licensed Mental Health (LMHP) Practitioners who are linking to new group.

Existing/credentialed providers who are linking to new group should submit required Provider Enrollment Form to assigned account executive.

Upon the receipt of linkage request, ACLA will load provider linkage into its claim processing system effective with the date of receipt.

Non-Licensed Behavioral Health Providers

The provider will submit a provider enrollment form and all required documents to their assigned account executive. View a complete list of required documents.

Adding locations

The provider will submit a provider contact form found on our website to add a new location.

Re-credentialing

From March through September 2020, in alignment with NCQA, ACLA has extended the recredentialing cycle to 38 months.  

Approval Letters

ACLA Credentialing Approval & Provider Welcome letters will continue to run on a weekly basis. These letters are submitted to a centralized mailroom and mailed on Wednesday.

Delegation Audits

Delegation audits are required to be conducted on an annual basis per NCQA.  From March through September, NCQA has extended the timeline for delegation oversight to 14 months.  During the state of emergency, all delegation audits will be conducted remotely via telephone.

Appellate Reviews

Any appeals received during this timeframe will be conducted telephonically instead of in person.

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