DCH Prepares to Launch Credentialing for Fee-For-Service Only Providers

Effective January 7, Georgia’s Department of Community Health’s (DCH) Centralized Credentialing Verification Organization (CVO) will be responsible for credentialing and recredentialing Fee-for-Service Medicaid/PeachCare for Kids® providers that are not affiliated with a Care Management Organization (CMO). This change will result in a uniform credentialing process for both Fee-for-Service and CMO providers (providers associated with Amerigroup, Peach State, or WellCare).

The CVO’s one-source application process will:

• Save time;
• Increase efficiency; and
• Create one uniform credentialing and recredentialing process for both Fee-for-Service and CMO providers.

The CVO will perform primary source verification and query databases such as the American Medical Association’s National Practitioner Database for information on the provider, check required medical malpractice insurance, confirm Drug Enforcement Agency (DEA) numbers, etc. Once the provider’s application is approved for credentialing or recredentialing, this information will be forwarded to the CMOs who may begin contract discussions with interested providers.

Fee-for-Service Only providers will continue to utilize the existing web portal to submit all required credentialing documentation. The CVO will contact providers to inform them of when to begin the credentialing process.

If you have additional questions, contact your local HP Provider Relations representative at 1-800-766-4456 or go to www.mmis.georgia.gov to review the Frequency Asked Questions (FAQ).

Questions regarding the CMO contracting process should be directed to the specific CMO listed below: