Credentialing is the systematic process of collecting and verifying relevant education, training, licensure, professional references, background, and certifications to provide patient care before a provider is allowed to see patients. This process is intended to ensure that our members receive their care from providers who are appropriately trained, licensed, and meet quality standards. WellHealth Quality Care uses a process called primary source verification to validate required credentialing information including, education, training, licensure, DEA registration, work history, hospital affiliations, and insurance coverage. This process, among others, is verified by contacting the organization that originally issued the credential to the provider.
Join Our Network
WellHealth Quality Care is an Accountable Care Provider Network established to service commercially insured carriers and self-funded groups. WellHealth Quality Care contracts with multiple payors across the state of Nevada.
Because healthcare is about providing excellent care and seeing your patients’ health and wellbeing improve and flourish. Our goal is to change the way healthcare is experienced.
In essence, we want to shape the way the healthcare model of tomorrow looks and functions. Our Network is comprised of the best providers in Nevada, and we pride ourselves on the quality of care they provide. Once contracted and credentialed through WellHealth, providers can choose to opt in and participate with our payor partners without having to re-credential or re-contract every time.
Get Started Today!
We are currently accepting provider requests to join our network. Follow these easy steps to start the process of becoming part of the WellHealth Network.
- Complete an LOI Letter of Interest Form and a W-9 (for your group's TIN) and submit it to firstname.lastname@example.org or fax them to (702) 522-1357 with a rate proposal (if applicable) .
- Once we contact you, review your contractual agreement, sign, and return with completed credentialing applications for all of your associated providers.
- Credentialing will begin. Once completed, you will be notified, sent a copy of your executed contract, and welcomed to the network.
What to Expect
Both the contract and credentialing application (with supporting documents) must be submitted at the same time. Please remember that the process can take between 60 to 120 days from the time we receive your completed documents. For more information about the credentialing process, review the Credentialing FAQs.
Once we have received the necessary completed forms, WellHealth Quality Care will evaluate your specialty based on the current needs of our different Payor groups. If applicable, you will be sent a contract and credentialing application with instructions for submission.
After you are fully credentialed, you will receive a copy of your executed contract along with your credentialing letter(s).
WellHealth Quality Care is committed to supporting its participating providers through resources, tools, and Provider Advocates. If you have questions, please e-mail us at email@example.com or call us at (702) 728-5880.
These FAQs will help guide you through the credentialing process at WellHealth Quality Care.
Credentialing and network contracting are two separate processes. If credentialing is required a Nevada Standard Credentialing Application (for Arizona please click here) and a W-9 must be completed. E-mail the completed forms to firstname.lastname@example.org or fax them to 702-358-0362. The credentialing process must be successfully completed before a contract is executed.
No, WellHealth Quality Care will use the same credentialing application for all Payor Groups added to the contract.
Once the information is received, WellHealth Quality Care will evaluate your credentials as described above. When the credentialing process is completed, you will be notified in writing with your credentialing effective date and contracted date so your organization will know when they can begin to see patients.
Overall, the credentialing standards are established by WellHealth Quality Care's Credentialing Committee. Additional standards are set by the National Committee for Quality Assurance (NCQA).
There are no appeal rights. The contracting committee has the right to add physicians/groups to the Network based on the needs of the Payor groups we partner with.
All credentialed providers are re-credentialed at least every three years.
The foundation of WellHealth Quality Care is the ability to ensure WellHealth patients are receiving the best care possible, resulting in better outcomes and ultimately lower health care costs.
WellHealth strongly supports the use of evidence-based medicine, accountable care measures and quality tracking programs.
The WellHealth Quality Assurance Board is composed of medical professionals across all specialties. Each board is comprised of a Medical Director and five to eight peers in the same specialty. By creating a peer-to-peer assurance board, it allows for patient care to be put back in the hands of the providers.
Clinical outcome data is regularly reviewed by our Chief Medical Officer along with each of the WellHealth Quality Assurance Board members to ensure our providers are adhering to the highest standards of quality care. WellHealth providers are differentiated in the community and with insurers as high quality, accountable physicians.
Medical Professional Liability
Medical Professional Liability protects the livelihood of physicians. WellHealth Quality Care works hand-in-hand with organizations that have proven success in their field. WellHealth endorses Premier Physicians Insurance Company as our chosen medical professional liability insurance carrier.
About Premier Physicians Insurance Company
Founded in 2006, Premier Physicians Insurance Company is the only fully Nevada-based company offering Medical Professional Liability coverage. Medicine is a local business and so is your medical malpractice coverage. With offices in Northern and Southern Nevada, they are there for you - in person – when you need them. They understand your needs because the core of their company was formed by doctors, for doctors. The Board of Directors is made up entirely of physicians brought together from a variety of medical specialties. Thanks to their insight, they have the most physician-friendly model in the industry with a primary focus on supporting evidence-based medicine through proactive risk management. Furthermore, their aggressive claim response strategies provide a stable term solution for medical malpractice liability insurance.
Protect What You've Built
WellHealth providers are offered preferred pricing for coverage through our Premier Access platform of services. Please contact one of our partner agents for more information.
Communications for Providers
The following communications are specific to each payor group. Communication pieces will only apply to all WellHealth Network Plans if stated in the subject line.