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Welcome Aspirus Medicare Advantage Providers

Our Network

The information and tools below will assist you with credentialing information for the Aspirus Health Plan Medicare Advantage network and ensuring your demographic information is up to date. If you are new to our network, please see the Working With Aspirus Health Plan – Medicare Advantage (PDF).

Provider Directory

The latest version of the Medicare Advantage Provider Directory is available on the Member Resources page under each plan listing.

Join Our Network

If you are interested in joining the Medicare Advantage network, please:

Credentialing and Recredentialing

  • See providers that require credentialing in the Provider Credentialing chapter of the Aspirus Health Plan’s Provider Manual (PDF).
  • If a non-credentialed type, please refer to “Add or Update a Non-Credentialed Practitioner” in the “Manage/Update Your Information” section below.
  • Providing services to members before you are both contracted and credentialed will result in claims being denied, rejected or processed as out-of-network.
  • Each practitioner within your practice will have their own credentialing approval date. These dates may vary across practitioners, even if they are part of the same practice.
  • Credentialed practitioners are enrolled in all plans/products that the clinic/group is contracted under.
  • Recredentialing is performed every thirty-six months, or earlier for any recredentialing files with variations from credentialing. Recredentialing is conditional upon the practitioner continuing to meet Aspirus Health Plan’s credentialing standards and quality performance standards.
  • All actions related to acceptance, denial, discipline and termination of participation status for a practitioner or organization are governed by Aspirus Health Plan’s Credentialing Plan (PDF).
  • For additional information including the Credentialing/Recredentialing Process, please see the Provider Credentialing chapter of Aspirus Health Plan’s Provider Manual (PDF).
  • Aspirus Health Plan’s Credentialing Department has a dedicated email box for credentialing-related questions – credentialingMA@aspirushealthplan.com.

Initial Credentialing

Practitioners may submit their credentialing application by completing the Uniform Credentialing Application (PDF) or the CAQH application and sending it to credentialingMA@aspirushealthplan.com.

  • Applications should be submitted at least three months prior to an individual practitioner’s start date at a clinic.
  • Aspirus Health Plan uses a standard 90-day turnaround time and does not retrospectively apply effective dates.

For credentialing questions, or if you are having difficulty downloading credentialing forms, please email credentialingMA@aspirushealthplan.com.

PLEASE NOTE: If an application is incomplete, it will be returned and notification will be sent back to the submitter. The application will need to be resubmitted along with all missing information. The 90-day turnaround will start once a completed application is received.

Recredentialing

  • When recredentialing is requested from Aspirus Health Plan, applications should be submitted to credentialingMA@aspirushealthplan.com
  • If an individual practitioner’s recredentialing application is not submitted in the time allowed, the practitioner’s Aspirus Health Plan participating network status will be administratively terminated. Once terminated, no claims will pay, and the practitioner will need to complete the initial credentialing process.

Submit your Uniform Facility Credentialing Application (PDF) for initial credentialing or recredentialing via email to credentialingMA@aspirushealthplan.com.

For credentialing questions, please email credentialingMA@aspirushealthplan.com.

Chiropractic – Fulcrum Health Inc.: 1-877-886-4941 toll-free
Dental – Delta Dental: 1-800-836-0490, option 2
Hearing – TruHearing, Inc.: 1-855-286-0550 toll free

Manage / Update Your Information

Ensure that Aspirus Health Plan has accurate information for your organization, location and service providers.

Uniform Practitioner Add-Change Form (PDF)
Submit to: credentialingMA@aspirushealthplan.com
or Fax: 715-787-7321

Please Note: To add new locations or facility/location changes, new practitioners, non-credentialed practitioners except as noted,* use the proper form in the drawers below to make these types of changes.

*Non-credentialed provider specialties: Audiologists, Certified Registered Nurse Anesthetist (CRNA), Nutrition, Occupational Therapists, Physical Therapists, Speech Therapists, Anesthesiology, Hospital-based Practitioners (not including Hospital-based Psychiatrists or Hospitalists) and Radiologists.

See the Provider Manual for a list of providers that do not require credentialing.
Non-Credentialed Practitioner Add Form (PDF)
Non-Credentialed Practitioner Change Form (PDF)
Non-Credentialed Practitioner Terminate Form (PDF)

Incomplete forms will be returned without processing. Please allow 30 calendar days for your request to be completed. For status checks, please contact Aspirus Health Plan’s Medicare Advantage Provider Assistance Center at 715-631-7412 or toll free at 1-855-931-4851.

Location Add Form (PDF)
Location Demographic/Update Form (PDF) (tax ID, legal name, ownership, address, phone, NPI)
Location Close Form (PDF)

If you contract with a third-party biller to call on your behalf to Aspirus Health Plan, we need a signed acknowledgement form on file giving Aspirus Health Plan permission to release information. Please use the following form to provide this information.

Provider Notification/Change/Update/Termination Third-Party Agreement (PDF)

Notifications, changes, updates and terminations must be received directly from the provider, not the third party.

Incomplete forms will be returned without processing. Please allow 30 calendar days for your request to be completed. For status checks, please contact Aspirus Health Plan’s Provider Assistance Center at 715-631-7412 or toll free at 1-855-931-4851.