Practitioner credentialing

Credentialing is the important and necessary process of obtaining, verifying, and assessing the qualifications of a health care practitioner to provide patient care services in or for a health care organization.

Your rights

You have the right to review information submitted in support of your credentialing application and to correct erroneous information. You may not review peer reviews, peer references, and other peer-review protected materials.

You also have the right, upon request, to be informed of the status of your credentialing or recredentialing application.

Initial credentialing

You must be credentialed before providing covered services to our members. This includes new practitioners who are joining an already credentialed group practice.

To initiate the credentialing process, you must fill out the proper forms to join the network, or to add someone to your group.

View requirements, forms and apply to join.

Provider Services will review and forward your information to the Credentialing department.

Applications for initial credentialing and recredentialing are only accepted through the approved universal credentialing data sources. Please submit your Washington Practitioner Application form (WPA) through CAQH. You must select "Kaiser Foundation Health Plan, Washington Region" to allow us to view/pull your application. Paper applications are not accepted.

You must complete our credentialing process and be approved by our Credentialing Committee. We will notify you in writing when your application is approved. The contracting process begins once credentialing approval is completed.

Recredentialing

You must be recredentialed every three years. Among other things, we assess the following:

• Outcomes from patient complaints
• Quality improvement activities
• Member satisfaction

Other quality measures may be adopted by Kaiser Permanente as well. We may also initiate a facility or medical record audit at any time based on patient complaints or other concerns.