Joining and Staying in the Umpqua Health Provider Network
To maintain the highest standards of care, we require all participating providers to complete credentialing before delivering services — and recredentialing every 36 months thereafter.
This process ensures member safety, supports regulatory compliance, and confirms that every provider meets the requirements set by Umpqua Health, the Oregon Health Authority (OHA), and the Centers for Medicare & Medicaid Services (CMS).
What Is Credentialing?
Credentialing is the process of verifying a provider’s qualifications — including education, training, licensure, and experience — to ensure they are eligible to care for our members. Recredentialing reaffirms those qualifications every three years.
This process applies to:
- Organizational providers (e.g., hospitals, clinics, and treatment facilities)
- Individual practitioners
- Behavioral health professionals
- Dental providers
- Traditional Health Workers
Who Must Be Credentialed?
Credentialing is required for:
- Licensed or certified independent practitioners
- Behavioral health and substance use disorder providers
- Non-licensed providers (e.g., QMHAs, QMHPs, CHWs, CADCs) under supervision
- Facilities delivering direct care (e.g., inpatient, residential, ambulatory)
- Providers offering telehealth or telemedicine
- Any provider listed in member-facing materials or contracted directly with UHA
If you’re not sure if you need to be credentialed, you may email UHNProviderServices@umpquahealth.com to inquire.
How the Process Works
Credentialing involves two key stages:
Contracting
Start by submitting a Provider Request Questionnaire. Our Contracting Workgroup will review your materials to determine network need and suitability.
Credentialing
If approved for participation, you’ll be invited to complete the credentialing process by submitting:
- A current Oregon Practitioner Credentialing Application (OPCA)
- All required documents (see FAQ below)
- Signed attestation and authorization forms
Incomplete or outdated applications will be returned.
Credentialing FAQ
- In addition to the OPCA, Providers should submit:
- Active Oregon license and DEA certificate (if applicable)
- A copy of your W9
- Malpractice insurance ($1M per occurrence / $3M aggregate minimum)
- Admitting privileges or hospital coverage plan (if applicable)
- Board certification, certifications (e.g., THW, CADC), or supervision plan (for non-licensed providers)
- Signed attestation and release forms
- Three peer references (for new applicants)
- UHN Demographic Questionnaire (languages, cultural competency, interpreter access)
- In addition to the facilities application, facilities/organizations should be prepared to submit:
- Current state licensure or regulatory approval
- Accreditation (e.g., Joint Commission, CARF) or a recent state/CMS quality review
- Credentialing and supervision policies (if applicable)
- Malpractice insurance ($1M per occurrence / $3M aggregate minimum)
- As part of primary source verification, we confirm:
- Licenses, certifications, and standing with regulatory boards
- Education, training, and board certification (if applicable)Medicaid/Medicare enrollment status and exclusion list screening (OIG, SAM, CMS)
- Hospital privileges, malpractice history, and insurance
- Peer references and supervision arrangements (for non-licensed providers)
- Compliance with required training (e.g., cultural responsiveness, trauma-informed care)
- Unaccredited providers may be subject to a site visit.
- Initial Credentialing: Umpqua Health has up to 120 days to complete credentialing after receiving a complete application, though most are processed sooner. Providers can avoid delays by ensuring applications are thorough and responding promptly to any requests. Missing or incomplete information is a common cause of delays.
- Credentialing Committee Review: Once verification is complete, your file is reviewed by our Credentialing Committee. Temporary or provisional approval may be granted in special circumstances, but full approval is required before you may begin treating our members as an in-network provider.
- Recredentialing (Every 36 Months): Providers are recredentialed every three years. We will notify you 3–6 months in advance. You’ll need to complete the Oregon Practitioner Recredentialing Application (OPRA) and submit updated documentation (e.g., license, insurance, certifications). Failure to complete recredentialing by the due date may result in network suspension.
- Facilities follow the same timeline and must also report changes in operations (e.g., ownership, accreditation status) between cycles.
Do not provide routine (non-emergency) services to our members until credentialing is complete. Services rendered before approval may not be reimbursed unless special arrangements (such as prior authorization) are made. If early participation is necessary, contact our team first.
If it’s been more than 120 days since submitting your complete application and you haven’t received an update, contact us directly for a status check.
We provide written notice once a credentialing decision is made. You will also be notified if your application is denied or additional documentation is needed. Providers whose contracts will not be renewed will receive written notice before the contract expiration date.
Please notify us at UHNProviderServices@umpquahealth.com or fax notice of change to (541) 229-4782 and we will provide you with next steps based on the circumstances.
We’re Here to Support You
Umpqua Health’s Credentialing Team is available to assist you at every step of the process.
Thank you for your continued partnership in providing high-quality, person-centered care to our members.