Be sure to update CAQH for any new PCP providers you add to LHP

We’d like to remind practices as you submit new PCP or Pediatric providers for inclusion in the Legacy Health Partners network, please ensure their CAQH (Council for Affordable Quality Healthcare) profiles are fully updated to meet Humana’s credentialing requirements. This helps prevent claim denials and ensures timely patient care. Humana provider network effective dates are 30 calendar days after all required documentation is received in the CAQH. As a reminder, LHP sends provider rosters to all our payors once at the end of every month.

Below is a list of the key CAQH requirements for Humana. Additionally, clinics should notify Humana of any billing address changes by emailing: PacificNorthwest@humana.com.
Thank you for your attention to these details which ensure timely credentialing and care for patients.

1. Current Medicare Provider Transaction Access Number (PTAN) or CMS Certification number (CCN ID) must be entered under professional IDs


2. Current in same State Drug Enforcement Administration (DEA) on file in documents section (must be valid from start date with group and for at least 45 days into the future)


3. Current in same State malpractice (PLI-Private Liability Insurance) on file in documents section (must be valid from start date with group and for at least 45 days into the future)


4. Current in same-state medical license on file in documents section (must be valid from start date with group and for at least 45 days into the future)


5. Same State hospital admitting privileges indicated or the name of a specific individual in the group that can admit patients listed or hospitalist group name, address and phone number. Please note that “pending” is not adequate.


6. Practice location section completed for your group


7. School/Training/work history for 5 years prior to starting with your group, up to and including your group’s information. Please note that any gaps of 6 months or longer must include a gap explanation section.


8. Attestation must be current; the application questionnaire must be complete, and the Consent and Release Form must be signed and dated within the last 180 days. An explanation must be provided for any affirmative answers on the questionnaire.


9. The provider/clinic has granted access to Humana to view the CAQH credentialing information.