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Credentialing

Keystone First VIP Choice (HMO SNP) is responsible for the credentialing and re-credentialing of its provider network. All providers credentialed by Keystone First VIP Choice must also be enrolled with the Medicare program and, as such, must agree to comply with all pertinent Medicare regulations.

Getting credentialed

Keystone First VIP Choice works with the Council for Affordable Quality Healthcare (CAQH) to offer providers a universal provider data source that simplifies and streamlines the data collection process for credentialing and re-credentialing.

To obtain information on all the required credentialing documents, in addition to those found in a provider's CAQH record—or for providers who prefer a paper credentialing process—please contact Keystone First VIP Choice Provider Services for assistance at 1-800-521-6007 or your local Account Executive.

Additional credentialing information:

For a complete list of the types of practitioners and facilities that Keystone First VIP Choice (HMO SNP) is responsible for credentialing, see the Provider Manual (PDF).

Practitioner and organizational provider credentialing rights

After the submission of applications, health care providers have the following rights:

  • To review information submitted to support their credentialing applications, with the exception of references, recommendations, and peer-protected information obtained by the plan.
  • To correct erroneous information. When information obtained by the Credentialing department varies substantially from information provided by the provider, the Credentialing department will notify the provider to correct the discrepancy.
  • To be informed, upon request, of the status of their credentialing or recredentialing applications.
  • To be notified within 60 calendar days of the Credentialing Committee or Medical Director review decision.
  • To appeal any credentialing or recredentialing denial within 30 calendar days of receiving written notification of the decision.
  • To know that all documentation and other information received for the purpose of credentialing and recredentialing is considered confidential and is stored in a secure location that is only accessed by authorized plan associates.
  • To receive notification of these rights.

To request any of the above, providers should contact the Keystone First VIP Choice Corporate Credentialing department at:

Keystone First VIP Choice
Attn: Credentialing Department
200 Stevens Drive
Philadelphia, PA 19113