First Choice Health Home : PPO Network : For Providers : Provider Application

First Choice Health is a Preferred Provider Organization (PPO) serving the Pacific Northwest. We offer access to our network of quality healthcare providers to various contract holders, or payors, such as commercial insurers or third party administrators, that sponsor employer groups' access to our network of providers in Washington, Alaska, Idaho and Oregon as part of their benefit plan.

All healthcare professionals must successfully complete our comprehensive credentialing process to be accepted as a First Choice Health (FCH) Preferred Provider. This process ensures that all providers in the network meet a specific set of standards before they are approved to render services to the members utilizing our network. In certain instances, FCH delegates the provider credentialing process to organizations recognized for being in compliance with our credentialing standards.

To begin the credentialing process, please complete our standard application. We accept the Washington Practitioner Application (WPA) for all providers located in Alaska, Idaho, Oregon and Washington.

All applicants MUST review the following Provider Credentialing Requirements and information prior to submitting an application.

• An Introduction to First Choice Health
• FCH Recognized Specialty List
• Minimum Requirements for Credentialing
• Additional Requirements for Allied Health Care Providers
• Criteria for Denial and Termination
• Appeals Process

Provider Credentialing Applications

Alaska:

• Alaska Practitioner Application

Idaho:

• Checklist for Application Completion
• Idaho Statewide Credentialing Application

Oregon:

• Oregon Statewide Credentialing Application

Washington:

• Washington Practitioner Application

If you have already completed one of the Credentialing Applications reference above, FCH will accept that application as long as it is current and completed in its entirety.

Please return your application, along with supporting documents to:

First Choice Health
One Union Square
ATTN: Credentialing Department
P.O. Box 2449
600 University Street, Suite 1400
Seattle, WA 98101

Provider Group Agreement

Participation with FCHN requires the signature of an authorized contact person and date. The Agreement MUST be returned along with the credentialing application.

Once we receive your completed application, we will verify education, licenses, practice history, professional liability coverage, hospital affiliation, malpractice history, and any history of sanctions. Participation in the FCH PPO Network depends upon the results of the verifications and of review of your application by our Credentialing Committee. The committee meets the second Wednesday of each month and our average time for processing applications is 90 days from receipt.

If you successfully complete the credentialing process, you will be notified in writing of your effective date with FCH PPO Network. Effective dates are not assigned retroactively and are not determined by the date you submit your application, sign your contract, or begin your practice. Once credentialed, providers are then scheduled to be re-credentialed every three years. We will automatically send you the re-credentialing materials prior to your three-year anniversary date.

If you are a large group of health care professionals, your group may be eligible for network participation based on Delegated Credentialing.

Additional Information

To obtain additional information about our credentialing requirements and how to join First Choice Health Network, please contact our Credentialing Department at 1-800-231-6935 extension 2106 or e-mail us.

• To obtain a Sample Fee Schedule, please call Provider Relations at 1-800-231-6935 extension 2103.
• To download a W-9 Form, please visit the Forms and Publications page of the Internal Revenue Service Website and select "Form and Instruction number ".

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