We make every effort to process credentialing and contracting submissions promptly. To avoid delays, please ensure all required documents are included with application submission. In addition, please double-check that all forms are signed and dated.

Provider Credentialing Applications

If you do not have an active agreement, complete this form: Contract Request Form – Groups.

For currently contracted groups, complete and return the following forms to credential a new practitioner: 

• Initial Credentialing Application
• Prescription Plan 
• Behavioral Health Expertise Addendum

For providers who are exclusively facility-based, please complete the Provider Update Form.

Facilities Provider Credentialing 

Review the Facility Criteria for Participation Guidelines.

Complete the Contract Request Form – Facilities to initiate the contracting process for a facility that is not currently contracted.

Recredentialing

Listed below are the providers who received Approved Recredentialing since the beginning of the year. If the provider or facility name is not listed, you can assume the recredentialing application has not yet been approved.

• St. Luke's Health Partners Approved Recredentialed Providers: January - March 2024 (Excel - .xlsx)
  This list is also available as a PDF (.pdf)

Adds, Changes, Terms

Complete the Provider Update Form to:

• Add a currently credentialed or facility-based provider to an existing group
• Update provider demographic information for existing providers 
• Remove a provider from your group 

Group Contracting

Review the SLHP Contracted Payer Product List – 2024.

Complete the Contract Request Form – Groups to initiate the contracting process for a group that is not currently contracted.

Clinical Integration Data Form

Provider Directory and Data Management

Effective January 1, 2022, Congress passed the No Surprises Act (NSA) which dictates how health plans (fully insured health plans, insurance carriers, and self-funded medical plans) and provider organizations communicate and share data. NSA requirements include: 

1. Attestation every 90 days. Providers must attest every 90 days to ensure provider demographic information is current and accurate. St. Luke’s Health Partners and BrightPath engage with a third-party vendor for advanced analytics that automatically flag stale, incomplete, or otherwise suspect directory data for follow up. Validation processes include on-demand human resolution, as well as closed-loop feedback interactions with participating providers. The database integrates seamlessly with the Provider Directory to ensure that directory updates are accurate, reliable, and compliant.  


2. Out-of-compliance providers must be removed from Provider Directory. Providers that have not attested to their demographic information may be removed from the Provider Directory, in accordance with the NSA. The provider will remain an in-network provider but will not be visible in the Provider Directory.