Frequently Asked Questions
Q: Who is eligible to join the PHO?
A: All Physicians who are members of the Northwest Community Hospital Medical Staff are eligible to apply. Visit the PHO Physician Participation Criteria page for specific membership criteria.
Q: How long does it take to be credentialed?
A: Managed care entities have 180 days to complete the credentialing process. The PHO usually credentials a complete application within 90-120 days.
Q: What is the contracting process?
A: Once your application is approved, you will be given a PHO contract to sign and can decide which managed care plans you would like to participate in. New physician practices will be given an orientation to the PHO and the managed care contracts available, including contracted reimbursements.
Q: How soon will I be effective in the PHO?
A: Once the contract is signed, the appropriate managed care plans are notified of your participation. The managed care companies determine the effective date of the contract, usually within 30-60 days of notification. It will be your responsibility to verify your effective date through the managed care company.
Q: What kind of contracts does the PHO have?
A: The PHO has HMO and PPO contracts. Please contact the PHO for a current list of health plans available.
Q: What kind of site visit is required?
A: The PHO conducts office site visits and record reviews during initial credentialing and recredentialing when practices have added or changed office locations. Primary Care Physicians (Family Practice, Internal Medicine, Pediatrics), OB/GYNs and high volume mental health providers are subject to site visits. A copy of the site visit guidelines are available through the PHO.
Q: Why is there a credentialing fee?
A: This is fee designed to cover the direct administrative costs associated with the credentialing process and is being put into place, to ensure that the hospital is not providing and paying for services that are solely for the benefit of physicians.
Q: Can I use my Northwest Community Hospital credentialing or recredentialing application for the PHO?
A: No. While both entities use the state credentialing form, each entity has their own credentialing cycle. The credentialing forms and information requested is time sensitive and will require updated signatures and attachments.
Q: Can I use a CAQH application?
A: No. At this time the PHO credentialing program and current payors require the State of Illinois credentialing forms.