Enrollment - The process of loading a contracted and credentialed provider into MDwise internal systems, which includes loading for claims payment, and loading to the provider directory (if applicable).
Credentialing - The process of reviewing the qualifications and appropriateness of a
provider to join MDwise network. MDwise’s Credentialing requirements and processes
follows NCQA guidelines.
Contracting/Negotiating – The process MDwise and participating requester formally
executes an agreement for the provider to deliver medical services that outlines those
services including, reimbursement rates, scope of services and effective dates.
CAQH – The Council for Affordable Quality Healthcare
Missing/Incomplete Submission: Requests that are submitted with missing or incomplete
information will be withdrawn, and the submitter will receive a response advising of the
missing or incomplete information. Notification of an incomplete network participation
request will be sent to providers within five (5) business days after receipt of initial request.
Please note that if you are in receipt of a response indicating missing/incomplete
information, the network participation process has stopped at that point and will start over
(including applicable timeline requirements) once completed documents are received by
resubmitting the entire packet again to or via fax at
Complete Submission: If all required forms and documentation were accepted by the
Provider Relations Enrollment Team, the provider will receive an acknowledgement along
with an enrollment ticket reference and will begin the Credentialing, Contracting, and
Enrollment phase. New Contract Network Participation Requests will receive the MDwise
Participation Agreement for review and signature while affiliated practitioners, providers or
locations are credentialed.