Understanding contracting and enrollment
Refer to our “Becoming a network provider” tip sheet to learn about contracting, credentialing, and enrollment, and maintaining your CAQH profile.
Start with our Welcome Flyer
Once you are a participating provider, our Welcome Flyer will guide you through getting started with us, including registering for our secure portals, EFT, and our provider newsletter.
Credentialing is your next step
Credentialing is an important step in being able to provide care to our members. Refer to the credentialing information below and begin with CAQH ProView.
- We will return a contract to you for review. The contract should be reviewed, signed and sent back to us to initiate credentialing.
- Once the contract is finalized and you are approved as a participating provider, we will send you a welcome letter that includes your network participation effective date and useful resources.
- Generally, credentialing and contracting can take 1-2 months. However, that time frame is extended if the application is incomplete.
- Point32Health credentials affiliated providers when they join the network. Clinicians cannot provide services for members until the credentialing committee approves them for network participation.
- Credentialing occurs once the provider has a signed agreement with the Plan. The Credentialing team cannot process the application until all required materials are received. You will be notified by email if the application cannot be processed due to incomplete information.
- Applicant requesting an initial affiliation with Point32Health will be credentialed through the HCAS process, utilizing CAQH’s ProView system, a central repository for credentialing information. Data from CAQH ProView will only be transmitted to plans with which clinicians are already contracted or are in the process of contracting. For more information about HCAS and its credentialing process, go to www.hcasma.org.
- Get started by visiting CAQH ProView.
Federal regulations require that providers who render services to Medicaid members are screened by and enrolled with the appropriate state Medicaid agency. This requirement applies to providers who participate in Tufts Health RITogether or Tufts Health Together.
- Tufts Health RITogether: Complete this screening and enrollment process via the Rhode Island Executive Office of Health and Human Services (EOHHS) provider portal.
- Tufts Health Together: Complete this screening and enrollment process via the MassHealth website. For more information, refer to this FAQ.
- Once you are a participating provider, please review this flyer to guide you through getting started with us. It will get you started with registering for our secure portals, signing up for our monthly electronic newsletter, registering for electronic funds transfer and more.
- We also encourage you to review our product specific Provider Manuals and our product pages.
Please note that, consistent with state requirements, Rhode Island providers requesting to join our Commercial network must also become participating providers in our Rhode Island Medicaid network for the Tufts Health RITogether product.