Contracting

PSW cares about our contracted providers and we aim to provide as much support to providers as possible. Explore the tabs below for provider information, credentialing and compliance assistance.

[accordion title=”2020 Provider Manual”]The PSW Provider Manual is intended for practices who hold a PSW provider agreement to deliver quality healthcare services to members enrolled in PSW contracted Medicare Advantage health plans. Providers and practices are encouraged to reference this document when seeking assistance on policies, procedures and contracted provider responsibilities. 2020 Provider Manual[/accordion][accordion title=”Credentialing”] PSW is delegated by its contracted health plans to assume all credentialing requirements for its Medicare Advantage
provider network. It is a requirement to demonstrate all providers meet Washington State, federal and other regulatory
or compliance requirements.

Provider Office Site Quality Review
For newly contracted Primary Care Providers, PSW is required to conduct an initial on-site survey to ensure all health plan requirements are met.

Office site standards that you must follow include:

• Physical accessibility, such as handicapped accessible;
• Physical appearance;
• Adequacy of waiting and examining room space;
• Availability of appointments; and
• Adequacy of treatment record keeping (e.g., secure/confidential ling system).

The credentialing program applies to the following provider types:

• Doctor of Medicine (MD)
• Doctor of Osteopathy (DO)
• Doctor of Podiatry (DPM)
• Doctor of Chiropractic Medicine (DC)
• Doctor of Optometry (OD)
• Physician Assistant (PA)
• Nurse Practitioner (NP)
• Physical Therapist (PT)

Re-Credentialing Process
PSW re-credentials network providers at least every 36 months. The process finds and evaluates changes in the providers which confirms the provider’s ability to deliver healthcare services:

• License
• Training
• Experience
• Competence
• Health status

Providers are encouraged to attest to all the data in your CAQH ProView or Provider One websites application every 120 days and maintain a complete and current application with supporting documentation, no further action is required. PSW credentialing department will access your information and follow the steps needed for re-credentialing. If your credentialing information is not current, PSW will reach out to the provider and/or  practice to request updated re-credentialing application form and attestation.

For questions or more information, please contact PSW’s Credentialing Department at (360) 943-4337 ext. 138 or visit the 2020 Provider Manual.[/accordion][accordion title=”Compliance”]

Compliance Officer:
Sara Aukerman 1-877-943-4337

Compliance Reporting:
To report suspected violations of or concerns related to Fraud, Waste and Abuse (FWA), Ethics or Compliance, please call:

PSW Compliance Department:
1-877-943-4337 option 7

Centers for Medicare and Medicaid:
1-800-455-4521

For complete compliance & ethic responsibilities, please refer to the 2020 Provider Manual.[/accordion]