Provider Credentialing FAQ

We appreciate your interest in becoming a part of the New West panel of participating physicians. Below are a few FAQs that may help you understand the process.

What is credentialing?

Credentialing is the process by which a health plan reviews and approves or disapproves a provider who is licensed, certified or registered to practice independently to provide services to our members as a participating provider of the plan. New West Health Services follows the standards and guidelines set forth by the National Committee for Quality Assurance (NCQA). This process includes primary verification of licensure, malpractice suits, and Board Certification, as well as verification of a DEA certificate (if applicable), malpractice liability insurance, and an attestation that covers several topics.

Recredentialing of all practitioners occurs at least every three years. The process is essentially the same as that followed in initial credentialing.

How long after I complete my application will it take to become a participating provider?

Typically, once an application is fully completed (i.e., all requested documentation from you has been received by New West), the time to final credentialing is approximately 45-60 days. This process includes review by the New West Medical Steering Committee, which must approve all new applicants to the panel. New West cannot backdate effective dates for credentialed Lines of Business, which includes the HMO and Medicare provider panels.

May I send a curriculum vitae instead of filling out the Work History portion of the application?

Yes, as long as the curriculum vitae is up-to-date, and includes at least the beginning and ending month for the most recent five years of work information, including your current position.

Who do I call if I have a question about the contract or fee schedule?

Please call your Provider Services Representative for this information. Your specific Provider Services Representative will depend on where your office is located:

If your primary office location is in the counties of Lincoln, Flathead, Sanders, Lake, Mineral, Missoula, Ravalli, Granite, Powell, Deer Lodge, Silver Bow, Beaverhead or Madison please mail to New West Health Services, Attn: Hilary Ambrose, 1203 Hwy 2 West Ste 45, Kalispell, MT, 59901. Her direct phone number is 406-751-3332.

If your primary office location is in the counties of Glacier, Toole, Liberty, Hill, Pondera, Teton, Choteau, Lewis & Clark , Cascade, Judith Basin, Jefferson, Broadwater, Meagher, Gallatin or Park please mail to New West Health Services, Attn: Doug Frazier, 130 Neill Ave, Helena, MT, 59601. His direct phone number is 406-457-2244.

If your primary office location is in the counties of Blaine, Phillips, Valley, Daniels, Sheridan, Roosevelt, Fergus, Petroleum, Garfield, McCone, Richland, Dawson, Prairie, Wibaux, Wheatland, Golden Valley, Musselshell, Rosebud, Custer, Fallon, Sweet Grass, Stillwater, Yellowstone, Treasure, Carbon, Big Horn, Powder River or Carter please mail to New West Health Services, Attn: Suzann Jones, 2132 Broadwater, Unit A1, Billings, MT, 59102. Her direct phone number is 406-255-0184.

Will I receive a copy of the contract once the process is complete?

Yes, a copy of the finalized contract will be sent to you once you are approved as a participating provider by the Medical Steering Committee and it is signed by the Vice President of External and Provider Relations.