To comply with the State of Hawaii’s Act 192 mandating health care provider network adequacy and accreditation, HWMG is required to verify the credentials of our participating providers. Our credentialing process is designed to ensure providers meet our credentialing criteria as required by our administrative policies, URAC health network accreditation standards, and governmental regulations. The process is generally as follows:
- New Providers (such as those joining a participating contracted practice) are subject to the initial credentialing process prior to joining the network and being listed in the HWMG Provider Directory.
- Participating Providers (those initially credentialed and already participating in our network) are subject to the recredentialing process at least once every three years from the date initially credentialed by HWMG in order to maintain their participation status.
To complete an initial credentialing application for HWMG, you may choose one of the following options:
For those who prefer paper forms, we will accept the following.
- HWMG’s Credentialing Application for Practitioners or Hospitals/Facilities
- An application used by another organization may be acceptable at the discretion of our Credentialing Committee, so long as it is in accordance with our credentialing criteria; and HWMG’s Authorization, Attestation, and Release form for Practitioners (or Facilities) must also be signed and dated at the time of submission.
Return the completed application, authorization form, and supporting documentation to HWMG.
CAQH ProView is an online solution provided at no cost to you, developed to save practitioners the time it would take to complete lengthy paper forms. Once your data has been entered, you may update and attest to your information at any time. CAQH has resources available, including short how-to videos. You may also call their Help Desk toll-free at (888) 599-1771.
- If you already have a CAQH ProView account, please follow these steps to ensure your information is current, and provide us with your CAQH ID so we can add you to our roster. If you are a group practice and unsure if your practitioners are registered, simply provide us with the practitioner’s name and birthdate, and we will gladly check to see whether they have a CAQH ProView account.
- Login to CAQH ProView to update and/or re-attest to your CAQH credentialing profile at least once a year – the tool will prompt you to do so.
- Add new documents to replace any expired ones (e.g., a current copy of your liability insurance).
- Leave no gaps in your work history for the most recent five years, or list the reasons for any gaps.
- Allow Hawaii-Western Management Group (HWMG) to access your profile.
- If you are not registered with CAQH, you may self-register through the CAQH ProView Provider Portal at any time. After self-registering, practitioners will receive a welcome email with an assigned CAQH ID. They may then login to ProView and follow the prompts to complete a profile and credentialing application. Once submitted, please provide us with the practitioner’s assigned CAQH ID so we can add it to our roster.
A provider group or facility may perform credentialing activities for their practitioners on HWMG’s behalf, so long as a Credentialing Delegation Agreement with HWMG is executed and all credentialing-related requirements are met. For further information, please contact our Credentialing Department.
Participating Providers (those initially credentialed and already participating in our network) are subject to the recredentialing process at least once every three years from the date initially credentialed by HWMG in order to maintain their participation status. For recredentialing, you may submit one of the following.
- Recredentialing Verification Form for Practitioners or Hospitals/Facilities
- Updated Credentialing Application for Practitioners or Hospitals/Facilities
Upon receipt of the required form and attachments, the provider is considered to be recredentialed unless notified otherwise.
What Happens After Completing a Credentialing Application?
- You will need to submit your completed application and required documents directly to HWMG’s Credentialing Department or upload it into CAQH ProView. If uploading to CAQH ProView, please notify our Credentialing Department to confirm your submission.
- HWMG will verify applications and supporting documentation as part of the credentialing process. This includes contacting the primary source of particular credentials (e.g., state licensing boards and school programs). The processing time can be up to 90 days to accommodate license verification and clarification of discrepancies. You will be notified of any issues noted during this process.
- Once we verify all of your information, we will present it for peer review by our Credentialing Committee (composed of network physicians) and our Chief Medical Officer.
- Providers subject to the initial credentialing process will be notified within 10 business days of the Committee’s decision.