Credentialing

Physicians Health Network and PHP Insurance Company Networks may be closed to some specialties Prior to sending us a request to participate, please note that occasionally due to network size and utilization, Physicians Health Plan and PHP Insurance Company may close network participation to new providers. Currently the network is closed for the following specialties:

Ambulatory Surgical Centers - Closed in all Counties

Behavioral Health -Closed in all Counties (Excluding MD/DO and BCBA Specialties)

Chiropractic - Closed in Ingham and Eaton Counties

DME - Closed in all Counties

Home Health Care - Closed in all Counties

Hospice Services - Closed in all Counties

Lab - Closed in all Counties

Physical/Occupational Therapy - Closed in Ingham and Eaton Counties

To Join the Network


If you are a provider located in one of the counties PHP serves and would like to be considered for participation, please contact PHP.Credentialing@phpmm.org to initiate the credentialing process. All provider applications are reviewed in accordance with applicable Michigan laws regarding HMO provider panels. Once an application is received, it will be reviewed and you will either be mailed a participation agreement for your signature (for solo practices), or if PHP has a sufficient number of providers in your specialty area, you will be sent a letter declining your participation request.

PHP accepts the Council for Affordable Quality Healthcare (CAQH) credentialing application and the Mid-Michigan Uniform Credentialing Application. Currently, PHP has a sufficient number of providers in most specialties, including - but not limited to: laboratory, chiropractic, durable medical equipment, outpatient surgical centers, optometrists, physical therapy and behavioral health management services.
 
When a provider completes an application, signs the contract (if applicable) and returns them both to PHP, the application will be forwarded to the primary verification organization to begin the credentialing process. The following documentation and information is collected:

  • Signed attestation
  • Identification and documentation explaining gaps in work history (if more than three months)
  • Signed release of information
  • Signed substitute Form W-9
  • Signed disclosure addendum
  • Collaborative Agreement between applicant and physician (for advance practice nurses only)
  • CLIA Certificate (if applicable)
  • Documentation of medical education and training
  • Copy of DEA (if applicable) and controlled substance license
  • Copy of license
  • Copy of malpractice insurance, including effective and expiration dates, dollar amount and name of the insurance company
  • Identification of participating hospitals in which provider has clinical staff privileges and primary admitting facility
  • Absence of or uncomplicated malpractice issues
  • Explanation of any malpractice issues
Many steps are required in the application review, and we value your cooperation during this process. We are obligated to maintain a consistent procedure with each applicant, and our policy does not allow us to authorize services prior to approval by the Credentialing and Peer Review Committee. This is to ensure the quality of the services we provide, as well as to fulfill our responsibility to our members.

Please note that applicants have the right to:
  • Review information submitted to support their credentialing application
  • Correct erroneous information
  • Receive the status of their credentialing or recredentialing application upon request

PHP Credentialing Plan