Managed Care Organization Credentialing

YMG contracts with over 25 managed care organizations (MCOs). All MCOs utilize a credentialing process before allowing providers to receive patient referrals and payment. Several of these health plans do their own credentialing and require an application specific to that plan. There are several other plans that have “delegated” the duties of credentialing to the YMG. The delegation of credentialing to YMG is a benefit to you because it significantly decreases turnaround time to become a participating plan provider. To be reimbursed for services through these plans, you must complete the UCA.

From this point forward when your medical license is renewed, you must forward a copy of the new license to the YMG Credentialing & Provider Relations office. It is absolutely critical that you keep your license current and have it renewed long before the expiration date, to ensure that you do not lose your billing privileges. Remember that payers require substantial lead-time in credentialing so it is in your best interest to renew your license early.

If you have any questions regarding the credentialing process or are unclear as to what materials are required, please contact Vheegee Castaneda in the Credentialing & Provider Relations office at 785-7998 or via e-mail at Virginia.Castaneda@yale.edu

Each clinical department also has a Managed Care Coordinator (MCC) who serves as your departmental liaison with the YMG Credentialing & Provider Relations office. Your MCC is responsible for facilitating the credentialing and application process.