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Delegated Providers

If your provider group has a delegated credentialing agreement with Health Net Federal Services, LLC (HNFS), full roster submissions are required quarterly, with updates recommended a minimum of once a month. 

How to Submit Provider Rosters 

HNFS offers two options for provider roster submission:

  1. Submit online using CAQH® ProView for Groups®.
  2. Use HNFS’ TRICARE Provider Roster template and contact your designated Delegated Compliance Auditor for questions on the template and submitting.
    • We require delegated groups using the email option to submit provider rosters using our TRICARE Provider Roster template, as it includes all the data elements required for referral, provider directory and claims payment purposes. 
    • If you are unable to use the TRICARE Provider Roster template, your designated Delegated Compliance Auditor will work with you to make sure the provider rosters you submit have all required elements.
    • Please contact your designated Delegated Compliance Auditor concerning any questions.

Frequency of Provider Roster Submissions

Full provider rosters

  • HNFS requires delegated groups submit a full provider roster at least quarterly (every 90 days). 
  • Per the delegated credentialing agreement, groups should submit full provider rosters within 10 days of their quarterly credentialing committee meetings.

Updates

  • HNFS recommends delegated groups send provider roster updates a minimum of once a month; however, we will accept updates weekly or even daily. 
  • If there are no changes in a given month, we ask groups still send an email indicating “no updates to report.”

If after 30 days from submitting your provider roster you experience claims issues due to effective dates, contact us for assistance.

Learn More about CAQH ProView for Groups

HNFS has partnered with CAQH ProView® to offer an easy solution for delegated provider groups to maintain and share provider rosters with multiple health plans. CAQH ProView for Groups is an easy to use, secure web portal that lets provider groups submit a single provider roster of their delegated providers for all participating health plans. The standard provider roster format meets data needs for enrollment, delegation oversight and directory maintenance. 

How it works: 

  • Prepare one single delegated provider roster using the standard CAQH group provider roster format. 
  • Upload the provider roster in CAQH ProView for Groups. Log in to the CAQH ProView for Groups web portal and click “upload roster.” The system will automatically check the provider roster for errors. 
  • Resolve any data errors. 
  • Authorize health plans, including HNFS, access. Each plan will only see the data for the delegated providers in their network. 
  • Track health plan access. 

Please contact your designated Delegated Compliance Auditor to get started. 

To learn more about CAQH ProView for Groups, visit CAQH’s ProView page or register for a Groups Perspective webinar

Delegated Credentialing Resources

Credentialing questions? Please contact your designated Delegated Compliance Auditor for more information.