Credentialing/Enrollment

SoNE HEALTH performs the essential function of credentialing on behalf of its members. SoNE HEALTH provides credentialing for physicians.

Credentialing at SoNE HEALTH means less paperwork for practitioners and their office staff and one point of contact for SoNE HEALTH payors. SoNE HEALTH credentialing and recredentialing follow the standards of the National Committee for Quality Assurance (NCQA). SoNE HEALTH has been approved by the majority of the payors to perform this function on their behalf through delegation agreements which speed up the overall enrollment process.

The recredentialing process is done at least triennially and this information is communicated regularly to the delegated managed care plans. SoNE HEALTH utilizes the Council for Affordable Quality Healthcare (CAQH) online database to obtain the majority of provider information necessary to complete recredentialing; this further eliminating requests for additional paperwork from the majority of our practitioners.

 

A requirement for SoNE HEALTH physician membership is Board Certification.  Physicians must obtain board certification in their practicing specialty within seven years of their last education and training or as determined by the specific board.  Once obtained, board certification must be maintained to continue participation with SoNE HEALTH.

Allied Health Practitioners must also be certified upon credentialing and must maintain their certification to continue participation with SoNE HEALTH.

Physicians must also contact SoNE HEALTH directly by Email for a SoNE HEALTH credentialing/enrollment packet.  The packet included the documents necessary for the insurance credentialing with SoNE HEALTH’s contracted payors.

SoNE HEALTH also monitors and manages all aspects of practitioner enrollment to its delegated payors including changes and terminations.

Please send any changes or terminations in writing by  Email.