Important Messages

Prospective Participating Providers
Effective March 12, 2010 Atlantis has implemented a temporary freeze on the processing of new provider applications due to an increased volume in the receipt of provider applications.  We expect to begin accepting new applications shortly. Please check back periodically for new updates to this message.

Providers who recently submitted an application for participation
If you have recently submitted your application, we ask for your continued patience during the credentialing review process.  Please respond promptly to any follow-up requests for additional documentation.  Your timely response will help facilitate the credentialing process.

Atlantis Health Plan (“Atlantis”) appreciates your interest in obtaining more information about becoming a participating provider.  To assist in expediting the process by which you can join our network we have included several links (found below) that direct you to attachments including our Provider Application, Provider Contract and other valuable information. In addition, we encourage you to visit our “Find a Physician” provider search where you can find a listing of our current participating hospitals and other providers within our network.

We are happy to inform you that Atlantis now participates in the Council for Affordable Quality Healthcare (CAQH) program. By providing your CAQH number on our provider application, we will be able to obtain your updated credentials through the Universal Provider Data Source that they operate. However, if you do not have a CAQH account you must complete the full provider application and submit the following documents:

• Current New York State License with provider's signature
• Current Federal DEA Registration
• Curriculum Vitae
• W-9 Form for each billing location
• Copy of Board Certification
• Professional Liability Insurance Face Sheet
• Letter of Hospital Admitting Privileges from a participating hospital

Please send the above documents to:

	Provider Application Form		Health Insurance Claim Form (HCFA 1500)
	W9		Provider Profile Update
	Participating Provider Agreement		Provider Group Agreement
	Behavioral Health Information		Participating Hospitals
	CPT Fee Schedule Request Form