Membership - Physicians/Nurse Practitioners/Physician Assistants

Credentialing and Enrollment

Are you a new provider in the PPOC? Are you welcoming a new provider to your practice? Please see the applicable section to make sure you have the appropriate materials in order to be credentialed and enrolled or to credential and enroll your new provider in PPOC contracts.

All questions should be directed to PPOC_Credentialing@childrens.harvard.edu

Physician/MD Credentialing

In order to receive the physician application, a request should be sent to PPOC_Credentialing@childrens.harvard.edu . The application will be sent electronically to both the MD and the practice manager/credentialing contact within two business days.

The sooner the application is completed, the sooner the PPOC can get everything submitted to the Medical Service Office (MSO).  Whatever support the physician can provide in assisting with the verifications, etc. is appreciated. Sometimes the delays are a direct result of lack of response from previous employers/organizations.

Please keep in mind that you should expect that it will take a minimum of 4-5 months from the PPOC’s receipt of a new application for that physician to be fully attached to the PPOC contracts.  In many cases, the process can take even longer, particularly if the physician has an extensive work history.

Behavioral Health Provider Credentialing

All requests for behavioral health provider applications needs to come from the PPOC Behavioral Health Integration team. Please contact your Behavioral Health Program Manager for more information.

Please keep in mind that you should expect that it will take a minimum of 4-5 months from the PPOC’s receipt of a new application for that behavioral health provider to be fully attached to the PPOC contracts.

NP/PA Membership and Contracting

Please contact us for the credentialing packet. As with physician members, you will need to submit the completed packet so that we can evaluate your qualifications. Your credentials will be verified by Boston Children’s Hospital, and a committee of PPOC members will then review the information you have supplied. Next, the committee will recommend applicants to the PPOC Board of Directors for final approval. It is our expectation that the vast majority, if not all, of the nurse practitioners and physician assistants who apply will have no difficulty gaining membership.

It’s important to know that by becoming a member, we are not necessarily changing your relationship with insurance companies. In fact, the insurance companies will not know whether or not you are a PPOC member unless you choose to become a participating provider on the PPOC contracts. You will continue to have the flexibility to either bill for your services “incident to” a physician or to be designated as a primary care provider who has their own panel of patients. Over time, we hope to use our contracting process to achieve better rates for those of you billing independently, but that will require discussions with each insurer as the contracts are renewed.   In the interim, please contact us for the contracting packet if you are interested in participating on the PPOC contracts.