Provider Support Services

• Before credentialing can begin, a provider must first be determined eligible for contracting.
• Interested behavioral health or substance use disorder providers should contact the Provider Network Unit at pihpprovidernetwork@dwihn.org.
• A basic eligibility review will be conducted. If approved, the provider will move forward to onboarding.

• Approved providers will receive an onboarding training video and a link to complete the credentialing application.
• All provider organizations must be credentialed in compliance with our contract.
• Eligible clinical staff may also need to be credentialed based on MDHHS Provider Qualifications outlined in the MDHHS Medicaid Provider Manual.

Our Credentialing Verification Organization (CVO) reviews submitted information and checks the following databases:

• Office of Inspector General (OIG)
• System for Award Management (SAM)
• MDHHS Sanctioned Provider List
• CMS Exclusion List

This ensures that providers/practitioners are not excluded from participation in Medicaid or Medicare programs.

• The Credentialing Committee, chaired by the DWIHN Medical Director or their physician designee, reviews the application and verification results.
• The committee may approve the provider for inclusion in the DWIHN Provider Panel or deny the application.

• Credentialing is the first step toward becoming a contracted DWIHN provider — it does not guarantee a contract.
• All contracted providers and all clinicians delivering services within our network must be credentialed.
• Questions regarding the credentialing process can be directed to pihpcredentialing@dwihn.org.

• If a practitioner receives an adverse credentialing decision, they have the right to appeal.
• The letter sent regarding an adverse decision will have an appeal document attached that must be returned within 30 calendar days of the decision in order to get a review by the Appeals Committee.
  • Failure to send a valid request for appeal within 30 calendar days allotted shall constitute waiver by the practitioner of any right to appeal.
• The applicant has the right and will receive a decision within 7 business days of the final disposition.
• The right to review information submitted to support the credentialing application
• The applicant has the right to review information obtained by the CVO to evaluate their credentialing application, attestation or Curriculum Vitae (CV).
  • The applicant must send a request in writing to the CVO.
  • The CVO may share information obtained from any outside source, such as malpractice insurance carriers, state licensing boards, with the exception of references, recommendations or other peer-review protected information.
  • The applicant must submit missing documentation within 14 calendar days of notification that file submission is incomplete.
• The right to correct erroneous information
• The right to receive the status of the credentialing or re-credentialing application upon request
• The right to be informed about the information it is allowed to share with practitioners.
• The right to be informed about the process for responding to requests for application status.