Affinity Health Plan

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  • Provider Credentialing

    Welcome to the credentialing page for participating providers of Affinity Health Plan. Here, you will find information and documents to help you learn about and complete the credentialing process. Participating providers can also use these resources for re-credentialing. If you have questions about credentialing, you may also contact our provider relations, contracting and credentialing department.

    Affinity has simplified the provider credentialing process by adopting the Universal Credentialing DataSource developed by the not-for-profit Committee for Affordable Quality Healthcare (CAQH). Providers registered with CAQH need to complete the online credentialing application just once, and then select the organizations who may access it. Other benefits of CAQH credentialing:

        » Registration is no-cost and hassle-free (no paperwork)

        » Information security (assured through password protection)

        » Regular information updates (status change requests are limited to three times yearly)

    Credentialing/directory listing for ID/AIDS/HIV providers

    AIDS/HIV providers may be listed in the Affinity provider directories as AIDS/HIV Specialists or as “HIV Experienced Providers” if they meet certain criteria. Learn more 

    Certain providers joining a participating group practice may be provisionally credentialed. Please click here for more information.

    Ownership, Debarment and Criminal Convictions

    Before Affinity enters into or renews an agreement with your practice or corporate entity, you must disclose any debarment or suspension status and any criminal convictions related to federal health care programs of yourself and your managing employees and anyone with an ownership or controlling interest in your practice or corporate entity.

    In addition, if the ownership or controlling interest of your practice or corporate entity changes, you have an obligation to notify us immediately. This also includes ownership and controlling interest by a spouse, parent, child or sibling. Please contact us by using the contact information in the reporting section below. If you have ownership of a related medical entity where there are significant financial transactions, you may be required to provide information on your business dealings upon request. If you fail to provide this information, we are prohibited from doing business with you. Please refer to the Code of Federal Regulations (CFR) 42 CFR 455.100-106 for more information and definitions of relevant terms.

    All requests for disclosure of ownership, controlling interest, business transactions, or related information made by Affinity or a governmental agency must be fulfilled within 35 days of the date of a request. It should be noted that at minimum, Affinity providers, vendors, and business partners must review the Social Security Administration's Death Master File, the National Plan and Provider Enumeration System (NPPES), the Office of Inspector General (OIG) List of Excluded Individuals and Entities (LEIE), the General Service Administration (GSA) Excluded Parties Lists System (EPLS), and the New York State Office of Medicaid Inspector General (OMIG) Medicaid Terminations and Exclusions list prior to hiring or contracting of any new employee, temporary employee, volunteer, consultant, governing body member, or First Tier, Downstream, and Related Entity (FDR) to ensure that none of these persons or entities are excluded or become excluded from participation in federal or state programs.  The LEIE and EPLS screenings must also occur at least monthly thereafter; the OMIG Medicaid Terminations and Exclusions list must be checked periodically after being hired or contracted.