Credentialing

Credentialing is the process of obtaining and reviewing documentation for the purpose of determining participation in our network. The documentation may include, but is not limited to, the applicant's education, training, clinical privileges, experience, licensure, accreditation, certifications, professional liability insurance, malpractice history and professional competence. Generally, the goal is to verify that the information received is complete and accurate.

To begin this process, you will need a current and completed CAQH application or you will need to complete an HS1 Credentialing application. Aside from a completed application, the following supporting documents must accompany the application:

• Consent and Release and Attestation with signature and date
• Copy of Curriculum Vitae, including work history in a month/year format to include the last five years
• Copy of DEA and/or CDS Certificate
• Copy of malpractice insurance face sheet
• Summary of pending or settled malpractice cases
• Ownership Disclosure and ADA Forms

TNNJ participates with CAQH, a service that provides a fast and easy way to securely submit credentialing information for individual providers to multiple plans and networks by entering information just once. Application data can be submitted online at any time. This simplified credentialing process reduces paperwork and saves time for health care providers and their staff members. Best of all, this service is provided at no cost to participating health care providers.

• Individual health care providers wishing to join the network may use CAQH for the initial credentialing process.
• A CAQH application can be used in lieu of completing an HS1 Credentialing application during the recredentialing process.
• Health care providers need to grant HS1 access to their applications on CAQH in order for TNNJ to utilize them.
• The application on CAQH also must be current and have all of its sections filled out completely as specified within the application.
• Current documentation (e.g., licensure and certifications) also must be attached as directed.

How CAQH Works

Health care providers obtain their CAQH Provider ID directly from CAQH (link opens in new window) and completing a registration form. Once the form is submitted, the health care provider will receive an email from CAQH with a CAQH Provider ID. Then, he/she will be able to log into CAQH and create a user name and password, which are used to complete the online application.

The applications are stored in an online database and are always available to the health care provider to update, review or print.

Once a health care provider completes the process, automatic reminders are sent each quarter to prompt a review and update of the information.

For more information about CAQH, please visit the CAQH Website (link opens in new window).