Medical Credentialing in Washington State

Carlos Sanchez
Outline of Washington state over a photo of doctors walking

Every state has their own unique processes and nuances and medical credentialing in Washington state is no exception. 

The most important thing to know before you get started is that Washington requires all documents, applications, and information be submitted through their online portals. In many ways, this speeds up the process, especially if you’re using the tips shared below.

Before looking specifically at provider credentialing in Washington state, let’s start with a definition. Provider credentialing is a systematic, multi-step process that healthcare organizations and insurance networks use to verify and assess the qualifications of medical providers. The primary goal is to ensure that providers meet specific standards for professionalism, education, training, experience, and competency. 

What’s Unique About Medical Credentialing in Washington State

Good news about credentialing in Washington: As of the writing of this article, the market is not saturated with providers, which means that most enrollments are processed quickly. Applications are often turned around in just a few weeks. 

Here are a few other ways that medical credentialing in Washington state is unique:

1. Required Use of Electronic Data Portals

The state of Washington uses OneHealthPort to manage credentialing and privileging. Using single sign on (SSO), it is easy to access multiple statewide online portals. In many cases, the provider is the only person who can see all information in their account.

  • ProviderSource: ProviderSource is part of  a statewide data collection portal for Washington healthcare. ProviderSource is the single source for provider credentialing and privileging information, as established in 2009 by state law. Providers upload information and documentation to the secure database and attest to it multiple times a year. This information is available to hospitals and health plans when it is needed.
  • ProviderOne: ProviderOne system is the system used by the Washington State Health Care Authority to enroll providers and pay claims for Apple Health (Washington’s Medicaid).

2. Practitioner Forms Require Wet Signature

In Washington, there are several forms that must be submitted together and contain a wet signature. These forms are the Washington Practitioner Attestation Questions, the Washington Practitioner Application, and Washington Practitioner Application Authorization and Release of Information Form. In many states, a stamped signature is fine, but with these forms, you will run into issues if you do not submit with a provider’s wet signature.

3. Washington Credentialing Specialists Are Very Helpful

Handling credentialing and enrollment in multiple states means that I am very familiar with state agencies and I have found that credentialing specialists with OneHealthPort and Washington State Health Care Authority are very knowledgeable, willing to help solve issues, and responsive. In other states it may take three to six months for a response, while in Washington, I have found most times I hear back within a few weeks. 

Steps To Complete Provider Credentialing in Washington State

Here are the general steps involved in completing medical credentialing in the state of Washington:

  • Managing ProviderSource Profile. Since all credentialing and privileging is completed online, maintaining an active login and completing attestations in a timely manner is critical. This is an ongoing requirement for medical credentialing in Washington state.
  • Primary Source Verification. Primary source verification involves contacting original sources — such as educational institutions, licensing boards, and certification bodies — to confirm the authenticity and accuracy of the documents and qualifications for the provider. 
  • Work History and Reference Checks. To assess the provider’s experience and reputation within the healthcare community, the work history of the provider must be verified without any gaps longer than 30 days. 
  • Background Checks. Comprehensive background checks help rule out any criminal history, malpractice claims, disciplinary actions, or other records that might send up red flags. 

Tips To Streamline the Credentialing Process in Washington State

While Washington’s online portals provide many benefits, they can be complicated to navigate when providers and administrators first get started. Providers must create their own account, so it’s a good idea to walk providers through the process and help them access information. With just one tiny detail missed, the application can be denied. 

1. Create an admin account.

Each provider must have their own account, but an administrator account can be created to oversee all providers within a group or facility. This provides critical information for credentialing because asking providers to stop during their day to call the state agency is very time consuming. With an admin account, you can’t view the data, but you can help providers to reset a password or update their email. 

2. Complete CAQH profile information AND ProviderSource information.

ProviderSource is not automatically pulling information from a provider’s CAQH profile. Every time an update is made to CAQH, the provider also needs to update ProviderSource. Many times this step is overlooked because they think all payers are checking CAQH. While national payers use CAQH, there are state-specific payers that will only use ProviderSource. 

3. Compare providers in the admin account to your roster.

Once your admin account is created, you can see how many of your organization’s providers have active accounts to compare to your roster. There are always lots of discrepancies between these two sources because providers are focused on caring for patients and not logging into the portal and keeping their account active. Without admin access to the portal, it is nearly impossible for administrators to know there are issues. 

4. Be meticulous about data entry.

Credentialing is a tedious process and if you’re missing one small detail, such as a peer reference, providers will not be able to attest their information. You really have to pay attention to detail to the information you’re putting on there because payers audit the information to a very detailed level.

5. Ensure providers login every 180 days.

If a provider doesn’t login to the ProviderSource account every 180 days, the account is deactivated. When payers notice the profile has been deactivated, they assume recredentialing is needed. This will force you to go through the recredentialing process even if it has only be six to eight months.

6. Follow alternate guidelines for tribal groups.

Tribal groups have their own tribal centers to treat tribe members and the state of Washington doesn’t require tribal providers to be credentialed. However, providers do need to be credentialed in order to apply with commercial payers. 

Keep Credentialing Organized for Washington State Providers 

A nearly entirely online process makes medical credentialing in Washington state different from other states where paper applications or PDFs are used. Maintaining good document organization and checklists will help to ensure all steps are completed with time to spare. 

Find out how MedTrainer can help — whether you just need software or you want a team of credentialing specialists to handle the process for you.