Provider Notice: Complete Credentialing Application Requirements
Beginning Nov. 1, 2026, Umpqua Health Alliance (UHA) will enforce its existing requirement that providers submit a complete credentialing application before the credentialing period begins and applicable in-network reimbursement provisions take effect.
This requirement aligns with Oregon House Bill 3242 (2025), which amended ORS 743B.454. Under the law, the credentialing period begins when UHA receives a complete application and ends when the application is approved or denied, or 90 days after receipt, whichever comes first.
For providers joining a group that is already in network, claims for covered medical services provided during the credentialing period must be paid at the same rate and according to the same payment schedule as in-network providers.
Required Application Information and Documentation
A credentialing application is considered complete only when it includes all required information and documentation:
- Provider information: Name, degree, home address, email address, date of birth, Social Security number, gender and other names used.
- Primary care provider (PCP) designation, if applicable
- Board certification, if applicable.
- Practice information: Name, address, phone number and fax number.
- Education history.
- Licenses, registrations, certifications and identification numbers, as applicable, including:
- Oregon license or registration and expiration date
- Drug Enforcement Administration (DEA) issue and expiration dates
- National Provider Identifier (NPI)
- Medicare number
- Oregon Medicaid number
- Physician associate collaborating physician or group
- Current hospital affiliations and privileges, if applicable.
- Pending hospital privilege applications, if applicable.
- Five years of work history, including month and year.
- Explanation of employment gaps longer than two months.
- Peer references, including name, specialty and email address.
- Current professional liability insurance information, including carrier, policy number, coverage limits, effective date, retroactive date (if applicable) and expiration date.
- Completed, signed and dated attestation questions, including explanations when applicable.
- Signed and dated Authorization and Release.
- Completed Attachment A, if applicable.
- Completed Attestation of Provider Seclusion and Restraint Policy, including a copy of the restraint and seclusion policy and procedure.
- Continuity-of-care plan for patients requiring hospital admission if the provider does not have hospital admitting privileges.
- Current curriculum vitae (CV) or résumé, with dates listed by month and year.
- Copies of applicable federal, state and local professional licenses, certifications and registrations, including DEA documentation.
- Liability or malpractice insurance fact sheet showing coverage amounts, effective and expiration dates, practice name and all individuals covered under the policy.
Incomplete Applications
Applications missing any required information or documentation are considered incomplete. The credentialing period does not begin until UHA receives a complete application. As a result, claims are not eligible for in-network reimbursement under the credentialing-period provisions until a complete application is received.
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.
Providers may begin seeing patients and submitting claims while their credentialing application is still in process. Umpqua Health will pay for covered services rendered during the credentialing period. The Umpqua Health contracted rate will be applied during credentialing; however, if a provider fails to submit all required and complete credentialing information within 90 days, or if credentialing requirements are not met, the provider group must repay the difference between in-network (contracted) and out-of-network reimbursement (non-contracted). We will notify you if your credentialing application is incomplete.
If more than 120 days have passed since you submitted your complete credentialing application and you have not received an update, contact Credentialing@DCIPA.com.
For questions about your effective date or billing, contact Provider Relations at UHNProviderServices@umpquahealth.com.
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.