Frequently Asked Questions

1. Verify that we accept applications for your provider specialty. Check here to verify.
2. Fill out our Provider Interest Form.
   You will need your Individual NPI Number and CAQH provider ID number since we use the Council for Affordable Quality Healthcare, INC. (CAQH) application.
3. Once we receive your form, we will begin the credentialing process. Please note, we do not have the ability to accept paper applications.
4. Allow up to 90 days for the credentialing process.

View more information

Review the accepted specialities.

If you received an error it may be for the following reasons:

• You were in the network prior and are currently termed
• You are already in the FCH network
• You have already completed the form to join the network and we are working on your request

Contact [email protected] and provide the practitioner name and NPI Number for research.

View the credentialing requirements

On average it can take up to 90 business days (does not include weekends and holidays).

You will receive a welcome letter via email with your effective date once the process has been completed.

Paper applications are no longer accepted.

Credentialing typically takes up to 90 business days from the submission date. Please wait until after this timeframe before requesting a status update.

If it is past 90 business days, please send an email to [email protected] and include Provider name, NPI number, TIN and practice location.

Typical turnaround is between 60-90 business days. You will receive a welcome letter via email with your effective date once the process has been completed.

Associate level providers are not credentialed.

Register at CAQH application to begin your CAQH application.

Yes, CertifyOS is our credentialing vendor. They will reach out if additional information is needed (check your spam folder regularly in case these emails go to there).

Email to [email protected] and include Group name, NPI number, TIN and practice location.

Email to [email protected] and include Group name, NPI number, TIN and practice location.

Please wait 90 days for CertifyOS to finish the credentialing process.

To fix this, confirm that the primary contact listed in the credentialing section of the provider's CAQH application is accurate and notify CertifyOS via email to update the contact information [email protected]

Email a delegated roster to [email protected]

Please make all demographic updates to the practitioner’s CAQH application and have them re-attest.

• To update this address type, send an email to [email protected] indicating you wish to change your billing address.
• Include your NPI and Tax Identification numbers so we can find you in our system.

Important Note - A billing address means the "pay to address" or where the checks need to be sent. It should match what is being sent in box 33 on the CMS 1500 or EDI form locator 2010AA (street address) or 2010AB (PO Box).

• If you are joining an existing TIN that is contracted with FCH, your new Tax ID (TIN) information must be reflected on your online CAQH application. Update the CAQH application and attest and we will update your demographic information.
• If you are adding a brand new TIN to FCH, add it to your CAQH application and attest. Then, email a W9 to [email protected] along with messaging indicating that you have added a new TIN and want to be contracted at that TIN.

Email a hospital based data requirement form to [email protected].

MT, WY, and Western SD - We credential and send them roster for those states only

Wyoming Counties: Albany, Big Horn, Campbell, Carbon, Converse, Crook, Fremont, Goshen, Hot Springs, Johnson, Laramie, Natrona, Niobrara, Park, Platte, Sheridan, Teton, Washakie, Weston

South Dakota Counties: Butte, Custer, Fall River, Lawrence, Meade, Pennington

Note: Providers must be loaded to the network by the 9th of the month in order to be sent on the 15th. If they are not, the update will not be sent to Aetna until the 15th of the following month.

First Choice Health operates as a PPO Medical Network, any insurance plan that uses the FCH PPO Network includes all providers currently contracted with FCH.

Payors that utilize the FCH PPO Network

• Send an email to [email protected] indicating you wish termination of a specific practice address.
• Include your NPI and Tax Identification numbers so we can find you in our system.

• If you are joining an existing TIN that is contracted with FCH:
  • Your new Tax ID (TIN) information must be reflected on your online application.
  • Update the application and attest and we will update your demographic information.
• If you are adding a new TIN to FCH:
  • Add it to your application and attest.
  • Then, email a W9 to [email protected] along with messaging indicating that you have added a new TIN.
• If you are terming an existing TIN:
  • Email [email protected] with the effective date of the termination.

For changes to new practice address, name change, specialty change, etc.

• Ensure your demographics are correct and accurate on your CAQH application.
• Once all your information has been updated and attested to, we will automatically get the updates and make the change in our system within 2 business days.

Email [email protected] and include the Provider name, NPI number, TIN and practice location.

FCH does not have a unique provider ID number. FCH uses your NPI or TIN.

Email [email protected] with the effective date of the termination and the Tax ID number you want the provider terminated from.

Email [email protected] with a copy of the new license.

Email [email protected] for a copy of the welcome letter.

Using single sign-on credentials from OneHealthPort, utilize our Medical Management Portal to:

• Request Pre-Authorization
• Check authorization requirements
• View authorization determination letter
• Submit a Case Management referral

To submit a request that does not use the portal, download a prior authorization request form.

Access the secure FCH Provider Portal or use the Claim Status Look Up Tool.

The Claim Status Look Up Tool allows registered users the ability to look up claims status when First Choice Health is the claim administrator (only for members with a member ID that starts with 870). Anyone can register for the Claim Status Look Up Tool.

Email [email protected] with a copy of the W-9.

Claims can be submitted electronically via your clearinghouse of choice.

We do not accept paper claims. Our clearinghouse partners offer the ability to enter a claim and submit it electronically.

FCH Payor ID: 91131

FCH does not accept paper claims. Our clearinghouse partners offer the ability to enter a claim and submit it electronically.

FCH has direct connections with the following clearinghouses:

• Availity
• Intelligent EDI (iEDI)
• Office Ally
  • Offers an online claim submission form
• Change Healthcare CHC Green System (formerly RelayHealth)
• SSI

For First Choice Health enroll through Zelis for Electronic Funds Transfer (EFT) and Electronic Remittance Advice (ERA/835) processing. For more information or assistance, contact a Zelis Provider Enrollment Advisor by calling (855) 774-4392 or email [email protected].

For other payors, please review the List of Payors and locate the vendor contact information for each payor, if available.

For First Choice Health, contact a Zelis Provider Enrollment Advisor by calling (855) 774-4392 or email [email protected].

For other payors, please contact the vendor for the payor in question. You can find their contact information on the List of Payors.

The following features are available in the secure FCH Provider portal:

• View Benefits & Eligibility
• Request & View Pre-Authorization Determination
• Claims Status & Payment
• Pre-check Coding Logic

Register for OneHealthPort and gain access to the FCH Provider Portal.

Contact OneHealthPort for technical support.

Access the secure Provider Portal or use the Claim Status Look Up Tool.

The Claim Status Look Up Tool allows registered users the ability to look up claims status when First Choice Health is the claim administrator (only for members with a member ID that starts with 870). Anyone can register for the Claim Status Look Up Tool.

For questions related to:

• Credentialing status
• Network participation
• Application updates
• Roster requests

Please email: [email protected]

Please email: [email protected]

For requests involving:

• Provider information updates
• Address changes
• Provider terminations

Please email: [email protected]

You can check claim status on our website, refer to the FCH Provider Portal or our claim status look up tool

Our Provider Portal also includes a prior authorization look-up tool and the ability to submit prior authorization requests. Refer to the portal to leverage these resources. For questions regarding how a claim was processed or paid, please contact Customer Care by phone 800-517-4078 or email [email protected].

First Choice Health Medical Management offers providers a variety of tools and resources to assist with patient care.

Contact our Intake Coordinators by phone (800) 808-0450 or by fax (888) 272-3289.