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To become a participating provider, please complete the necessary paperwork (contracting documents, credentialing documents, credentialing checklist and W-9), so that we can include your office as an in-network, contracted provider. Please click on the links listed below to obtain the appropriate contracting and credentialing documents for your provider type. Please be sure to provide all requested information, as missing information may delay inclusion as an in-network provider. Practitioners have certain rights throughout the credentialing process. Click here to download a copy of the Practitioner Credentialing Rights document.
PROVIDER CONTRACTS
Physician
Physician Participation Agreement - FFS
Physician Participation Agreement - CAP
Hospital
Hospital Participation Agreement
Medical Facility
Medical Facility Participation Agreement - FFS
Ancillary Provider
Ancillary Provider Participation Agreement - FFS
Ancillary Provider Participation Agreement - CAP
Independent Practice Association
IPA Participation Agreement - FFS
IPA Participation Agreement - CAP
PROVIDER CREDENTIALING DOCUMENTS
Primary Care Physician/Specialist Physician
'Ohana Medical Staff Credentialing Application
CAQH Credentialing Application
NP-PA- PT-OT-ST-AUD
‘Ohana Allied Health Credentialing Application
CAQH Credentialing Application
Community-Based Services
‘Ohana Community-Based Services Application
Ancillary/Health Care Delivery Organization
'Ohana Ancillary Application
All Provider Types
Contract and Credentialing Checklist
W-9 Form
If you are contracting with `Ohana for the first time, your contracting paperwork should be submitted to your local Provider Relations representative. See office listing below. If you have questions relating to contracting with `Ohana, please call the Provider Hotline at 888-846-4262 (TTY/TDD: 1-877-247-6272), select option 2 and request to be transferred to the Provider Relations department.
'Ohana Provider Relations Office
Plaza at Milltown
94-450 Mokuola St., Suite 106
Waipahu, HI 96797
Any questions regarding credentialing processes should be e-mailed to the Credentialing department at credentialing@wellcare.com , or call the Provider Hotline.
Notice To All Primary Care Physicians
Primary Care Physicians (PCPs) shall have admission and treatment privileges in a minimum of one general acute care hospital within the Plan network and on the island of service. For the island of Hawai'i, this means one general acute care hospital in East Hawai'i and one in West Hawai'i. If a PCP with an ambulatory practice does not have admission and treatment privileges, the PCP shall have written arrangements with at least one other provider with admitting and treatment privileges with an acute care hospital within the Plan’s network.
