Credentialing

Credentialing Process

Health Services for Children with Special Needs, Inc. (HSCSN) provides care to Medicaid recipients from birth to 26 years of age in the District of Columbia through its network of more than 4,000 providers. We serve more than 5,000 children and young adults with disabilities.

HSCSN uses various credentialing criteria and guidelines to verify the provider meets and maintains the standards for network participation. Credentialing with HSCSN begins after the provider or group has started the contracting process with HSCSN via the Contracting Department. During the credentialing process HSCSN verifies the following items where applicable:

• Acceptable professional liability (malpractice) insurance coverage, State Professional License, State-Controlled Dangerous Substance Certificate, and Clinical Laboratory Improvement Amendments (CLIA) Certificate
• Completion of the required HealthCheck Training for HealthCheck practitioners (PCPs)
• All active permits and registrations, including Drug Enforcement Administration
• Proof of Board Certification
• An Accreditation Certificate from a recognized accrediting body, Centers for Medicare and Medicaid Services (CMS) State Survey, or any applicable State Survey
• The absence of negative actions taken by any State board and/or governing entity
• Curriculum vitae and/or work history

Interested parties may apply for participation by completing an application through CAQH at https://www.caqh.org/providers or contact the CAQH Help Desk at 1-888-599-1771. Once your CAQH application has been accepted by CAQH, notify the HSCSN Credentialing Department via phone 202-974-4693 or email at c6@hschealth.org to advise that your application has been accepted by CAQH. All dental providers interested in participating with HSCSN should contact Delta Dental at 800-357-8258 or PR_governmentprograms@delta.org.

Completed credentialing applications will be reviewed by the Chief Medical Officer for final approval. Files that contain noted disputes, such as settled malpractice cases, license sanctions, etc., will be presented to the Credentialing Committee for review and determination.

Providers are re-credentialed every three (3) years. All verifications are primary source. HSCSN does reverify education and training during the recredentialing process.

Additional Check Points

Primary Care Providers providing well-child care for HSCSN enrollees up to age 21 are required by the DC Department of Health Care Finance to complete the HealthCheck Provider curriculum. Training is required every two years. PCP’s must complete a one-time varnish training to receive payment for services rendered. 

Cultural Competency Training helps to promote and improve clear communication between the provider and enrollee. HSCSN strives to educate our providers on the importance of cultural competency. Please take the time to complete a cultural competency training and update your CAQH application indicating the completion of your training.

Practitioner Credentialing Rights

During the credentialing and recredentialing process, applicants are entitled to: 

• Review the information submitted to support their credentialing application
• Correct erroneous information. When information is obtained by the Credentialing Department that varies substantially from the information the practitioner provided, the Credentialing Department will notify the practitioner to correct the discrepancy.
• Upon request, to be informed of the status of their credentialing or re-credentialing application, except peer-review protected information. Requests can be made via phone and email. The Credentialing Department will respond via email or phone call to the practitioner. 
• Be notified within 30 calendar days of the Credentialing Committee or Chief Medical Officer’s decision.
• Appeal credentialing and recredentialing denial within 30 calendar days of receiving written notification of the decision. 

To request, provide, or correct any information in your credentialing file send an email to credentialing@hschealth.org or call 202-495-7526.

Visit our Frequently Asked Questions for more information about the credentialing process.