Group Contract Requirement
Effective immediately, ProviDRs Care requires all providers, including current participating providers, to contract as a group. Previously, participating providers had the option to contract as a group or by each practitioner. This change will reduce the administrative burden for participating provider groups and allow us to streamline the contracting and credentialing process.
If you are uncertain you are contracted at the group level or are a new provider group that would like to participate in the ProviDRs Care Network, please complete the Group DOA and attach the required W-9 using the link below.
Joining the ProviDRs Care Network
If you are not already a participating network provider, we encourage you to learn the advantages of contracting with ProviDRs Care. We are committed to providing and maintaining a comprehensive provider network that delivers superior customer service and a high quality of care.
Our provider relations department is available to answer any questions you might have about participating with our network.
To participate in ProviDRs Care Network, complete and submit the applicable New Credentialing application. Applications will be reviewed and processed only after receiving all required documentation. Completed applications are reviewed monthly by the Membership and Peer Review Committee. New applicants will be notified in writing within 60 days of the Membership and Peer Review Committee’s decision per NCQA (National Committee for Quality Assurance) guidelines.
Member ID Cards
The ProviDRs Care Network logo appears on member ID cards, making it easy to confirm network participation and claims payment terms.
Referrals to Network Providers
Network providers are listed in our online directories for your reference. We encourage health plan members to seek ProviDRs Care Network providers.
Office orientation request
Please contact our Provider Relations department at (800) 801-9772 or by email at ProviderRelations@ProviDRsCare.net to request an orientation.
Check Your Claim Am I a Contracted Provider?Credentialing Applications
Credentialing Guidelines
Forms
Medica Prime Solution (Medicare Cost Product)
NexUS
Providers FAQ
Q. How do I get information regarding filing electronic claims?
A. Take a look at our EDI Vendor / Connectivity List by clicking here.
Q. How do I change our address?
A. Please use the Provider Changes document listed under Provider Forms to update your practice information, location, or billing information.
Q. How do I determine if a doctor is participating in ProviDRs Care Network?
A. All participating network providers are listed under our provider directories. You may access the directory by clicking here.
Q. I am interested in joining ProviDRs Care Network. How do I join?
A. If you are interested in participating in ProviDRs Care Network, you may complete the online application by selecting the applications link on the provider’s home page. If you have questions regarding network participation, please contact our provider relations department at (800) 801-9772 or by email at ProviderRelations@ProviDRsCare.net.
Q. Is pre-certification required? What number do I call for pre-certification?
A. Pre-certification information is found on the ID card along with the number to call for pre-certification.
Q. Is there a guide of employer groups?
A. Yes, ProviDRs Care Network publishes a listing of all the groups accessing the network. For an updated report, contact a Provider Relations representative at (316) 683-4111.
Q. What is (WPPA) ProviDRs Care Network?
A. WPPA ProviDRS Care Network is a Physician Owned Preferred Provider Organization (PPO). We are a comprehensive statewide network dedicated to delivering high-quality cost effective medical care to covered members.
Q. Where do member ID cards come from?
A. The member ID card is formatted and issued by the insurance company or payor.
Q. If ProviDRs Care Network can’t verify patient eligibility, then where do I call to verify benefits?
A. The Insurance company or payor assists with questions regarding insurance benefits, patient eligibility, or claim payment status. You can find the phone number for the payor on the patient identification card.
Q. What is the Repricing claims turn-around time?
A. Average turn-around-time is less than 1 day.