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Credentialing: Frequently Asked Questions

General Information

Question	Answer
How often are providers recredentialed?	Every 3 years.
How often are facilities and vendors recredentialed?	Every 3 years.
Do I need to complete a separate facility/vendor application for each location under the same Tax Identification Number (TIN)?	If under the same TIN, only one application is needed and a roster can be attached that lists the other locations and all required demographic information, including National Provider Identifier (NPI) and specialty.
I have multiple facilities/vendor locations under separate TINs, do I need to complete an application for each location?	Yes. When each location is under a different TIN, an application must be completed.
What is my "credentialing approval date"?	The date HNFS' Credentialing Committee approves the provider record; providers will receive an approval letter within 10 business days of approval.
Who should I contact for Network Provider Directory corrections?	Contact our customer service line.
I have a Provider Participation Agreement, am I a delegated provider?	HNFS' Provider Participation Agreement allows you to participate in the TRICARE West Region network. A deletgation agreement is separate and is for credentialing your group's providers.
How do I verify the network status of a provider practice location?	Refer to your Provider Participation Agreement or contact our customer service line for network status.
How do I access HNFS' Secure Tools?	Visit our Provider Website Registration page for registration details to access Secure Tools with a login.
How do I update points of contact and email addresses for my group?	Please complete our Provider Contract Questionnaire. Fax completed forms to 1-844-836-5818. Note: If you need to update the email address tied to your www.tricare-west.com account, log in and make the changes in the “My Account” section.

Credentialing

Question	Answer
Will TRICARE load a non–Medicare-certified provider?	If provider type is Medicare-eligible, TRICARE only requires an individual provider to participate in Medicare on a claim-by-claim basis.
Does TRICARE require pediatricians to be Medicare-certified?	Pediatricians are exempt from the Medicare certification requirement.
I'm a delegated provider, what is my credentialing approval date?	Refer to the initial credentialing date listed in your provider roster submission.
Who can assist with facility enrollments (additions) and/or updates?	Please contact our customer service line for assistance.
Does TRICARE credential urgent care centers?	No, the providers at the urgent care center location(s) are credentialed.

CAQH

Question	Answer
How do I create a CAQH Provider Data Portal (formerly CAQH ProView) account?	If you are new to CAQH Provider Data Portal, register for an account.
Why do I need to grant permission for HNFS to access my profile?	If HNFS is not granted authorization to access your profile, we will be unable to view and access your application. Your consent for us to view your profile is critical.
How often should I update my CAQH Provider Data Portal profile?	Refer to the CAQH Provider Data Portal Provider User Guide.
CAQH sent me a letter about attestation expiration, do I need to send HNFS an updated attestation form?	No. Log into your CAQH Provider Data Portal profile and update your attestation.

Claims

Question	Answer
Who should I contact regarding claim denials or other claim-related issues?	You can use our self-service online tools to look up claims status information. For additional assistance, please call our customer service line and follow the prompts for claims inquiries.

Referrals and Authorizations

Question	Answer
Who should I contact regarding referrals and authorizations?	You can use our self-service online tools to look up referral/authorization status details. For additional assistance, please call our customer service line and follow the prompts for referrals and authorizations.

Minnesota Credentialing Collaborative

Question	Answer
Do I need to grant HNFS permission to access my profile?	If HNFS is not granted authorization to access your profile, we will not be able to view and access your application. Your consent for us to view your profile is critical.
Can I use my CAQH Provider Data Portal (formerly CAQH ProView) account for credentialing?	Providers practicing in Minnesota have the option of using Minnesota Credentialing Collaborative (MCC) or CAQH Provider Data Portal applications for credentialing.
Can I switch my credentialing application organization?	Changing applications during your credentialing process may delay processing.