Become a First Choice Health PPO Network (FCH PPO) Preferred Provider
All healthcare professionals must successfully complete our comprehensive credentialing
process to be accepted as a First Choice Health PPO Network (FCH PPO) 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 PPO delegates the provider credentialing
process to organizations recognized for being in compliance with our credentialing
standards.
We accept the paper Washington Practitioner Application (WPA) for all providers
located in Washington, Oregon, Idaho and Alaska.
To begin the credentialing process, review the following Provider Credentialing
Requirements and information outlined below prior to submitting an application:
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Initial Credentialing Applicant
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Washington (except Clark County, WA: see Oregon):
Please be aware of our
Network Closure for select
specialties in Washington State.
Option 1:
In January 2011, Washington State now requires a centralized collection of provider
credentialing data to simplify the provider’s experience. OneHealthPort (OHP) hosts
the
ProviderSource application as a single source to enter your provider data
for credentialing. This service is free to providers entering their data. When you
use this service to complete an application, please upload images of the documents
identified in FCH PPO’s
WA Credentialing Checklist
, as well as a signed
Washington Release of information Form (ROI)
.
Option 2:
Download the documents below, and return to the address as detailed on the “Checklist
for Application Completion”.
Oregon (including Clark County, WA):
Idaho:
Alaska:
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Recredentialing Applicant
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If you have received a request for recredentialing, please complete the ProviderSource application and the FCH PPO
Release of Information Form (ROI)
and upload images of the required documents.
Additional Information
To obtain additional information about our initial credentialing or recredentialing
requirements, please contact FCH PPO Credentialing Department at (800) 231-6935,
option 6 or Ext. 2106, or e-mail us at CredentialingApp@fchn.com.
If you have questions regarding provider contracting or how to obtain a “Sample
Fee Schedule”, please call Provider Relations at (800) 231-6935 Ext. 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”.
If you are a provider applying for a contract with the First Choice Health Assistance
Services EAP, MAP, PAP please visit the Assistance Services section of our website
for additional information.
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