If your practice/organization (Tax ID) is out of network and interested in participating with Sentara Health Plans, please complete the Request for Participation form on the Join Our Network Page. 

Changes affecting your Provider/Facility/Ancillary Agreement (contract)? Tax ID, Legal Business Name, product/reimbursement changes or other changes affecting your Provider Agreement (contract) cannot be submitted on this form. Please contact your Contract Manager directly or reach out to the Network Contracting team at 877-865-6075  for these requests.

CMHRS/ARTs provider changes? Please contact your Contract Manager directly or reach out to the Network Contracting team at 877-865-6075 for these requests.

Physician and Physician Extenders

Adding a new provider to your practice?  Please review the provider credentialing requirements prior to submitting your Provider Update Form.
 
Prior to submitting your request for credentialing, please ensure:
  1. Provider is active in CAQH.
  2. Sentara Health Plans has access to provider CAQH profile.
  3. Make sure the account has been attested and the attestation date is 60 days before the re-attestation date.

Please note incomplete applications MAY be returned/rejected and if so, a new submission will be required.

Organizational Provider 

What is an Organizational Provider?  Facility or Ancillary healthcare provider for medical and/or behavioral health services. 
  • Facility - Free standing institution/location where healthcare is provided. 
    • i.e:  Hospital, Skilled Nursing Facility (SNF), Ambulatory Surgical Center (ASC)
  • Ancillary - A provider of services or supplies that supplement and/or support treatment by a physician or other healthcare professional.
    • i.e: Laboratory, Radiology/Imaging, Physical Therapy (PT), Occupational Therapy (OT), Speech Therapy (SP), Audiology, Hospice, Home Health, Ambulance, Cardiac Monitoring, IVF Therapy, Dialysis, Durable Medical Equipment (DME), Intensive Outpatient Programs (IOP), Office Based Opioid Treatment (OBOT), Opioid Treatment Program (OTP), ARTs/ASAM level of care 2.0-3.7. 
Facilities/Ancillary Provider Changes? To submit updates, the Tax ID must be contracted under a Type 2 Ancillary/Facility agreement. If your request includes a NEW or Change of NPI for the contracted Tax ID, please follow these steps:
  1. Download and complete the Organizational Provider Application.
  2. Ensure that all Required Documentation and the Organizational Provider Application is attached with your submission.
  3. When completing the request, select "Add Provider to Existing Practice" as the “Request Type”. Incomplete submissions will be returned.
Submit a Provider Update Form

Request Turnaround Time and Status Inquiries 

Please allow up to 30 days for the requested provider information to be updated in all Sentara Health Plans systems (60 days for new provider/credentialing requests). You (the requestor) will receive a confirmation email when your request has been completed. After 30 days (60 for new providers), if you have not received a confirmation email and/or do not see the updated information reflected on the provider’s profile in the Sentara Health Plans directory, send an email for status inquiries to:

Credentialing inquiries: SHPCredDept@sentara.com
Recredentialing inquiries: SHPRecred@sentara.com
Provider Update status inquiries: PUStatus@sentara.com

Submit Delegated Updates

Please note that the Provider Update Form is not intended for delegated providers. Instead, please use the Delegated Update Form.

If you have any questions, or need help, please contact us. You can find more useful resources for providers in our Provider Toolkit. The Provider Toolkit includes helpful “How To” information, sample member ID cards, and important forms.

Provider Support