Provider Credentialing

Credentialing can take 90-120 days once a completed application including all required forms and documents have been received.

Providers that are outside the scope of the Hometown Health credentialing program include paraprofessionals such as Registered Behavioral Technicians, Board Certified Assistant Behavior Analysts and Physical Therapy Assistants and ancillary providers such as Hospitalists, Pathologists, Diagnostic Radiologists, Anesthesiologists, Neonatologists, and Emergency room providers. If you have additional questions on credentialing and provider types, please reach out to ProviderUpdates@hometownhealth.com.

After submitting the add form to Provider Updates, you should receive a confirmation email within 2 weeks. If you do not receive this confirmation, please contact Credentialing at hthcredentialing@hometownhealth.com.

Please send status requests 90 days after receiving a confirmation email.

You should receive an email confirmation with a reference number. Please allow 45-60 business days excluding holidays for a response. If you have not received a response after 60 business days, please contact the contracting department at HTHContracting@HometownHealth.com if you have any questions.

We allow 30 days to receive information for incomplete applications before the application is withdrawn. If the requested information is not submitted within the 30 days, the application will be withdrawn, and the provider will be eligible to reapply in 90 days with the requested information.

Please list the specialty the provider will be practicing under, not their title or degree. APRNs and PACs will match their collaboration/supervising physicians or specialty of the office.

Please ensure to indicate if the provider is only a telehealth provider or office and telehealth on the add form. The provider will need to have applicable licensure in the practice state and professional liability (malpractice) insurance to cover the state. Please note, a blanket policy can be accepted if it explicitly states there is no exception of coverage in any practicing state.

Psychologists-can have an EPassport from PSYPACT to practice via telehealth with their current state license.

Yes, excluding:

1. Behavioral Health providers with exception of Psychiatry
2. Audiologists, Physical Therapy, Speech Therapy and Occupational Therapy, Acupuncture, Chiropractors

Hometown Health may credential a practitioner with a pending DEA certificate if there is a documented process allowing another practitioner with a valid DEA to prescribe on their behalf. For DEA or CDS-eligible practitioners without a certificate, Hometown Health will verify that a process is in place to designate another qualified practitioner to write prescriptions as needed.

The practitioner must possess current professional liability insurance, with minimum coverage of 1 million/3 million dollars from a carrier authorized to write such policies in the state of Nevada or the state in which the practice is located, if other than Nevada. Coverage under the Federal Tort Claims Act or NRS 41.038 with a statutory cap of NRS 41.035 is acceptable.  Please ensure the following when updating CAQH:

1. The information on the Certificate of Insurance (COI) and information supplied in CAQH must match
2. We require a copy of all current COIs listed on CAQH
3. The COI must show coverage for the state the provider is practicing in
4. Please ensure that the group COI is current, and the provider’s name is listed on the COI. If the provider’s name is not listed, please provide a letter detailing that the provider is covered under the policy on company letterhead
5. A blanket COI can be accepted if it explicitly states there is no exception of coverage in any practicing state
6. FTCA policies must have effective and expiration dates, along with the provider and group name

Hometown Health has a delegated credentialing agreement with Renown. If the provider has privileges at a Renown facility, further credentialing from Hometown Health is not required.

1. How do you know if your provider is Renown Delegated?
   • Provider will have privileges at a Renown facility or be in the process of seeking privileges at a Renown facility.
2. Do I still submit an add form for my provider?
   • Yes, please submit either before or after Renown’s approval. Ensure to list Renown on the add form.

Please use the most current forms which can be found here: https://hth.staging.renown.org/provider-partners/provider-forms/

All forms will have the correct contact listed at the bottom of the page. Please ensure to follow the directions for the subject line and to send to the correct contact to avoid delays in processing your request.

1. Provider Addition Forms: ProviderUpdates@HometownHealth.com
2. Provider Termination Forms: ProviderUpdates@HometownHealth.com
3. Demographic Change Forms: ProviderUpdates@HometownHealth.com
4. Provider Contact Update Forms: HTHProviderRelations@HometownHealth.com

Please list the primary location on the group add form. If there are additional locations where patients can schedule appointments, include them in a supplemental document. Please note, we will not accept more than five locations per provider. 

Providers and facilities are recredentialed every 3 years.

For providers our CVO, Andros, will initiate the recredentialing process approximately 120 days before re-credentialing is due. For facilities, the Hometown Health credentialing team will email a facility application prior to the re-credentialing date.

1. Please keep CAQH information up to date. If changes are made, please reattest every 120 days to ensure changes are saved.
2. The provider’s practice state must be listed in CAQH. For example, if practicing in NV, NV must be included as a practice state, and a completed NV attestation must be uploaded.
3. CAQH must include:
   1. All current state licensure
   2. Five year work history with current practice location as listed on the add form
   3. Languages spoken by providers and staff including ASL
   4. Practice Restrictions/Limitations such as age or sex
   5. Credentialing contact
   6. Practice location should match address listed on add form
   7. Employment information should match add form
   8. Hospital Affiliations are current
   9. Professional liability (malpractice) insurance should be updated and copies of all COIs listed must be uploaded to CAQH
   10. Attestation questions must be answered, with explanations provided as needed.
   11. If “Yes” is answered for questions K1 or K2, a Malpractice Worksheet must be completed.

Scope of practice form is required if a provider does not privileges at a Hometown Health contracted facility

Collaborative Agreements are required for APRNs:

• If the NV Nursing State board license has one of the following indicators:
  • Active Prescribing-CII-COLL – ascribed to all APRNs who have been granted authority to prescribe within the Schedule CII-V category and have provided a copy of his/her current protocol with a collaborative physician.
  • Active Prescribing-CII-COLL –D ascribed to all APRNs who have been granted authority to prescribe and dispense within the Schedule CII-V category and have provided a copy of his/her current protocol with a collaborative physician.
  • If the provider has completed the required clinical hours but still has a collaborating physician indicator on license, we can proceed with credentialing using the Attestation of Clinical APRN Experience form while the provider updates their license with the state.
• Required if the APRN will be practicing in CA

Supervisory Agreements are required for all Physician Assistants

Changes in licensures should be submitted on your office letterhead and emailed to Network Services at ProviderUpdates@hometownhealth.com or faxed to (775) 982-8003. If you think claims need to be reprocessed to reflect the current license, please refer to the Over/Under Payment Section of the Administrative Guidelines for guidance.

CAQH for the provider is updated and re-attested

1. A Provider Addition Form is completed and emailed to ProviderUpdates@hometownhealth.com
2. The Provider Addition Form, CAQH, and any documents supplied will be reviewed by Hometown Health Credentialing team
3. If there are items missing, an email will be sent to the group with a 30-day window to submit or correct required items
4. If no items are missing and the application is complete, the group will receive a confirmation email stating the credentialing process has started
5. Provider file is sent to our CVO for verifications
6. If there are any issues during the verification process, the group will receive an email for additional information
7. Verifications are returned from our CVO and reviewed by the Hometown Health credentialing team before sending for final approval
8. If there are actions or settlements identified on the National Practitioner Data Bank report or credentialing application within the last five years, the monthly Hometown Health Medical Affairs Committee (MAC) will review and make a credentialing determination decision
9. If there are no issues with the file, the completed application will be sent to the Medical Director for final approval
10. Provider will be added to our provider database and an approval letter will be sent to the contact listed on the add form

No, we do not retro credentialing approval dates.

1. Contracted Hospitals in Northern Nevada:
   • Renown Regional Medical Center
   • Renown South Meadows Medical Center
   • Carson Tahoe Regional Medical Center
   • Barton Memorial Hospital
   • Banner Churchill Community Hospital
   • Battle Mountain General Hospital
   • Carson Valley Medical Center
   • Tahoe Forest Hospital
   • Humboldt General Hospital
   • Northeastern Nevada Regional Hospital
   • William Bee Ririe
   • Mt Grant General Hospital
   • Pershing General Hospital
   • South Lyon Medical Center
2. Contracted Hospitals in Southern Nevada:
   • Mountain View Hospital
   • Sunrise Children’s Hospital
   • Southern Hills Hospital and Medical Center
   • Sunrise Hospital and Medical Center
   • University Medical Center
   • Desert View Hospital
   • Boulder City Hospital
   • Mesa View Regional Hospital
   • Grover C Dils Medical Center
   • Harmon Hospital

Please visit our online directory for current Ambulatory Surgical Clinics/Centers and Long Term Acute Care Hospitals, and Acute Rehabilitation Facilities.

Hometown Health has an established process for the credentialing and re-credentialing of practitioners and organizational facility providers. This process includes the establishment of a process for appealing negative credentialing/re-credentialing decisions by the Medical Affairs Committee (MAC). A practitioner or organizational facility provider whose application has not been accepted due to the following reasons is NOT eligible to access the appeals process:

• Network adequacy pertaining to that practitioner’s particular specialty, or
• Failure to comply with HTH’s request for additional information

Practitioners/organizational facility providers for all Hometown Health products whose applications have been denied will be informed of the following appeal rights and processes:

1. The Notice of Denial will include the reason for denial as well as the practitioner/organizational facility provider’s right to appeal to the Level I or Level II stage.
2. The practitioners/organizational facility provider has 30 days from receipt of the denial letter to request engaging the appeal process, for both the Level I and the Level II Appeals.

LEVEL I APPEAL

1. The Level I Appeal Process is only available to existing, contracting practitioners/organizational facility providers on the Hometown Health network. Initial, non-contracted, practitioners/organizational facility providers who have been reviewed and denied by the MAC may reapply in three years. The practitioners/organizational facility providers may only reapply twice for reconsideration before the application will no longer be considered further.

   The purpose of the Level I Appeal is to provide information the MAC may not have seen or to correct information the MAC used in making the recommendation for denial.

   Level I Appeal is initiated with a written request to the Hometown Health Credentialing Specialist or Supervisor of Network Services by the practitioner/organizational facility provider to appeal the MAC decision. The request for the appeal must be made within thirty days of receipt of the denial letter. If the practitioner/organizational facility provider does not request a Level I Appeal within 30 days, the Committee’s decision will be considered final on that date. The practitioner/organizational facility provider’s denial will then be reported to the NPDB within 30 days.

2. The Level I Appeal will be scheduled no later than 60 days after receipt of request by the denied practitioner/organizational facility provider unless agreed upon by both the appellant and MAC. The Level I Appeal is hosted by MAC and conducted by a threeperson panel comprised of selected participating and non-participating providers that were not involved in the initial denial decision. At least one practitioner must be a participating provider who is not otherwise involved in network management and who is a clinical peer of the participating provider that filed the dispute. The clinical peer will have the same licensure as the appellant.
3. The Level I Appeal will be considered informal, with the MAC minutes documenting the attendees, the highlights of the discussion, and the decision of the Committee. Attorneys are not invited to participate on behalf of the appellant at a Level I Appeal.
4. The appellant will be notified of the date and time of the meeting so he/she can call in and/or provide additional information. Any additional information supplied by the appellant must be received no later than two weeks before the scheduled appeal meeting in order to be considered at the meeting.
5. Any data the appellant supplies must be:

• • Detailed;
  • Documented in writing by the appellant and/or include copies of documents such as a license, DEA certificate, letters of support, etc. and • Verifiable, either orally, written or through Internet website data, through acceptable sources identified in Hometown Health’s Standards for Participation policy & procedure

6. The Committee will notify the practitioner in writing of its decision within ten (10) business days of the meeting. If the practitioner was denied, the written notification will contain an explanation of the reason(s) for the MAC’s decision and the practitioner’s right to submit a Level II Appeal.
7. The practitioner has thirty (30) days from receipt of the notification to request a Level II Appeal.
8. If the practitioner does not request a Level II Appeal within 30 days, the Committee’s decision will be considered final. The practitioner’s denial will then be reported to the NPDB within 30 days. Additionally, the contents of the denial letter will be reported to the Commissioner of Insurance and the denial letter will be made available to the Commissioner upon request pursuant to Nevada Revised Statute (NRS) 679B.124.

LEVEL II APPEAL

1. The Level II Appeal is initiated at the request of the practitioner/organizational facility provider writing the Senior Clinical Staff Person or his/her designee.
2. The Level II Appeal will be scheduled no later than 60 days after receipt of request by the denied practitioner/organizational facility provider unless agreed upon by both the appellant and MAC.
3. The Level II Appeal is conducted by a five-person panel composed of three selected participating and non-participating practitioners. The panel will also include Hometown Health’s CEO or designee and another Hometown Health staff member not involved in the Level I Appeal. At least one practitioner must be a participating provider who is not otherwise involved in network management and who is a clinical peer of the participating provider that filed the dispute. The clinical peer will have the same licensure as the appellant.
4. The Level II Appeal will be considered a formal appeal, and the appealing provider may be represented by counsel at his/her own expense. Minutes of the meeting will be taken.
5. The Senior Clinical Staff Person or his/her designee will present the reason(s) for the denial of credentialing of the practitioner/organizational facility provider.
6. The practitioner/organizational facility provider may provide any material he/she feels is relevant, but it must be:

• • Detailed
  • Documented in writing by the appellant and/or accompanied by supporting documentation, and
  • Verifiable; either orally, written, or through Internet website date, through acceptable sources identified in Hometown Health’s Standards for Participation policy and procedure.
  • Any material supplied by the appellant must be received no later than two weeks before the scheduled Level II Appeal meeting to be considered at the meeting.

7. The practitioner/organizational facility provider will be notified in writing of the panel’s decision within 10 business days of the meeting. The written notification will include the panel’s findings based upon the information considered. If the practitioner/organizational facility provider was denied, the written notification will contain NPDB reporting language and notify the practitioner/organizational facility provider that they can reapply in 3 years. The practitioner/organizational facility provider’s denial will then be reported to NPDB within 30 days of the decision. Additionally, the contents of the denial letter will be reported to the Commissioner of Insurance and the denial letter will be made available to the Commissioner upon request pursuant to Nevada Revised Statute (NRS) 679B.124.
8. All decisions from the Level II Appeals are considered final.