What We Do > Credentialing/Enrollment

SOHO HEALTH performs the essential function of credentialing on behalf of its members. SOHO HEALTH provides credentialing for practitioners with the following designations: MD, DO, DDS, DMD, DPM, PA, APRN, CNM and LMN.

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

The recredentialing process is done at least triennially and this information is communicated regularly to the managed care plans. In 2009, SOHO HEALTH began utilizing the Council for Affordable Quality Healthcare (CAQH) online database to obtain the majority of provider information necessary to complete recredentialing; thus further eliminating requests for additional paperwork from the majority of our practitioners.

Additionally, SOHO HEALTH and Saint Francis Hospital and Medical Center Medical Staff Office share a common physician application. Active or Courtesy membership, whether with or without clinical privileges at Saint Francis Hospital and Medical Center are required for SOHO HEALTH membership.

Allied Health Practitioners must obtain privileges through the Medical Staff Office at Saint Francis Hospital and Medical Center if they will be render any patient care within the hospital setting.

Practitioners interested in joining SOHO HEALTH begin the credentialing process by contacting the Medical Staff Office at 860.714.4088 to request an application for hospital membership/privileges. Completed physician applications are returned to the Medical Staff Office, which in turn submits application copies to SOHO HEALTH for credentialing.

Another requirement for SOHO 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 the SOHO HEALTH.

Allied Health Practitioners must also be certified upon credentialing and must maintain their certification in order to continue participation with SFHCP.

Physicians must also contact SOHO HEALTH directly at 860.714.5755 for a SOHO HEALTH credentialing/enrollment packet. The packet includes the documents necessary for the insurance credentialing with SOHO HEALTH’s contracted payors.

SOHO HEALTH also monitors and manages all aspects of practitioner enrollment to its contracted managed care plans including adds/changes/terminations, effective dates and provider numbers.

Contact Amy Mattex, Manager, Credentialing at 860.714.5755 for more information.

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