Thank you for your interest in participating in our WPS Provider Network. Please complete and submit this form. The information provided is used by WPS for assessment purposes only and is not a credentialing application or a Preferred Provider Contract. Completion of this form does not guarantee Network participation.
- Allow 30 minutes or more to complete the form
- *Denotes a required field
- If we require additional information from you and we do not receive the needed information within 15 business days your request will be denied
- Allow 60-90 days for review
This request only applies to the WPS Provider Network. For help with Medicare or TRICARE, please contact the appropriate entity.
Practitioner Rights Pertaining to Credentialing
Credentialing of practitioners is performed by the WPS Credentialing Department upon initial contracting of practitioners and every three years thereafter. Practitioners undergoing the credentialing process have the following rights:
- You have the right to review a summary of outside information obtained by the Credentialing Department for the purpose of evaluating your application.
- Requests to review a file shall be made to the Credentialing Manager. The review will take place on site during normal office hours.
- Providers shall not have access to references from other practitioners/health care facilities, recommendations, or peer-review protected information received as part of the credentialing process.
- Providers may receive a copy of only those documents provided by, or addressed personally to, the provider. A written summary of all other information shall be provided to the practitioner by the Medical Director or his/her designee.
- You will be promptly notified of information that varies significantly from the information you have provided and be given the opportunity to submit updated/additional documentation or corrections to the Credentialing Department. The correction of erroneous information must be done, in writing, within ten (10) days of being notified of the varying information. The Credentialing Department is not obligated to reveal the source of information if disclosure is prohibited by law.
- You have the right, upon request, to be informed of the status of your application at any time. Requests shall be directed to the Credentialing Manager. The Credentialing Manager shall promptly provide applicant with information regarding date of application receipt, general category of items outstanding, and target approval date.
- You will be notified of the Credentials Committee decision regarding your application via written letter within 60 calendar days of the committee's credentialing or re-credentialing decision.
If you have any questions regarding the contracting process, please contact GBNetworkDevelopmentDept@wpsic.com
