Are you interested in applying to be part of the Genesys PHO network?
It takes approximately 90 days to complete the Genesys PHO credentialing process. Once this process is complete, it may take the contracted health plans up to 90 additional days to process your application.
- To begin the Genesys PHO credentialing process for Specialist Providers, please contact our Credentialing Coordinator to request the application at CredentialingCoordinator@genesyspho.com.
- To begin the Genesys PHO credentialing process for Primary Care Physicians, please contact our Physician Recruiter to request the application at PhysicianRecruiter@genesyspho.com.
Genesys PHO is NCQA Accredited in Credentialing to provide full-scope credentialing services, including:
- Verification of practitioner credentials through a primary source, through a recognized source or through a contracted agent of the primary source.
- A designated credentialing committee that reviews practitioner credentials and makes credentialing recommendations.
- Monitoring practitioner sanctions, complaints and quality issues between re-credentialing cycles.
Key Functions include, but are not limited to:
- Genesys PHO is delegated for credentialing & re-credentialing (every three years) of Primary Care Physicians & Specialists with Managed Care health plans BCBS/BCN, Health Alliance Plan, Molina, Priority Health; also submit to Blue Cross Complete, Genesee Health Plan, MultiPlan/PHCS, and USA Health.
- New Provider Credentialing with Genesys PHO Contracted Health Plans
- Maintain Initial Credentialing with the Managed Care Health Plans
- Maintain credentialing documents and contracts for Providers
- Provider re-credentialing management and manage contract renewals
- Ensuring Physician information is accurate and up-to-date with insurance companies
- Medicare, Medicaid, and BCBS of MI Enrollment (if applicable)
- Enrollment and Revalidations of insurances - Medicare and Medicaid (if applicable)
- Re-attestation and Maintenance of CAQH on schedule (if applicable)
- Ongoing Monitoring – Provide alerts of malpractice and insurance license expiration dates
- Specialist Preferred Panel Participation
Looking for a bit more information on Genesys PHO's credentialing services? Check out some of our frequently asked questions below.
Credentialing is the validation of a provider in a private health plan and the approval to join the network. Provider Enrollment. Enrollment refers to the process of requesting participation in a health insurance network as a provider.
Payer enrollment (aka provider enrollment) credentials are specifically used for applying to an insurance panel. Medical credentialing is a repository of information to verify the valid status of a healthcare practice and each of its members.
Before a provider or organization can bill an insurance carrier, the provider must first be credentialed by the carrier. Credentialing is the process by which a health insurance carrier formally assesses a provider's qualifications, and competency based on demonstrated competence.
Provider credentialing is the process of establishing that medical providers have proper qualifications to perform their jobs. This requires contacting a range of organizations, including medical schools, licensing boards, and other entities, to verify that the providers have the correct licenses and certificates.
Credentialing is the process of obtaining, verifying, and assessing the qualifications of a practitioner to provide care or services in or for a healthcare organization. Credentials are documented evidence of licensure, education, training, experience, or other qualifications.
Credentialing is the process by which a healthcare organization assesses and confirms the qualifications of a practitioner. Privileging is the process of authorizing a licensed or certified healthcare practitioner's specific scope of patient care services.