Other payers: Tricare, Devoted Health plan and MultiPlan provider enrollment

How does Devoted Health plan provider enrollment work in Florida?

By our count from CMS’s October 2026 enrollment file, Devoted has 58,668 Florida Medicare Advantage members, 1.9% of the state’s 3,058,968 (6,720 in Miami-Dade).

1. Ask to join. If Devoted needs your specialty, it contacts you about a contract; if not, it keeps your information. Its credentialing team doesn’t answer join requests.
2. Have CAQH ready when you sign. Complete it, authorize Devoted and attest within the previous 90 days (the 2024 FAQ says 120). Missing items get up to three requests over 30 days; then the application closes. A denial can be appealed within 60 calendar days.
3. After approval. Send roster changes at least monthly and report any change within 30 days.
4. File and fix claims on time. A claim past the 90-day limit can’t be billed to the member; correct a denial within 180 days; each of the two payment-dispute levels is due within 90 calendar days.

Devoted credentials independently licensed practitioners; physician assistants are rostered but not credentialed or listed in the directory. Its FAQ says it credentials nurse practitioners in six full-practice-authority states, not Florida, and NPs elsewhere “if they request to hold a panel” (NP and PA credentialing).

Treating Devoted Special Needs Plan members, or members with Medicaid as secondary coverage? Devoted, citing 42 CFR 455.410, says you must be enrolled in Florida Medicaid at least on a ROPA (referring, ordering, prescribing or attending) basis, or crossover claims and prescriptions can be denied (Florida Medicaid enrollment).

Where do TRICARE and the other payers take credentialing applications?

Source: each payer’s documents under Official sources, read Oct 20, 2026.

AvMed routes behavioral health providers to Optum Behavioral Health and decides “based on network need and credentialing criteria.” An Oscar applicant without a Participation Agreement has no appeal rights.

Is TRICARE provider enrollment the same as TRICARE credentialing?

No. Humana Military, the East Region contractor (Florida included) and separate from Humana’s own plans, runs two steps.

Certification is enrollment. Every provider, network or not, must be TRICARE-authorized in each state where it practices to file claims and be paid. Certified alone, you’re “TRICARE-authorized non-network”: TRICARE Select, Reserve Select and TRICARE For Life patients, yes; Prime patients only through a network provider, an authorization or the point-of-service option. Recertify after two years without a claim, a move to a new state or an expired requirement. The rule still uses TRICARE’s former name, CHAMPUS:

“The individual must be currently licensed to render professional health care services in each state in which the individual renders services to CHAMPUS beneficiaries.”

Payment. Participating non-network providers accept the TRICARE-allowable charge as payment in full, claim by claim if they choose; non-participating providers may charge up to 15 percent more. East Region claims use payer ID 99727.

How do you get credentialed with TRICARE East?

Only network providers are credentialed, and they also sign a Humana Military contract. On Oct 20, 2026, Humana Military’s TRICARE Certification and Network Information page said it “is not currently accepting requests to join the medical, surgical or ancillary networks.” It takes Join the Network requests, one per tax ID, from providers certified for autism, psychiatry, mental health, substance abuse, doula or lactation (mental health credentialing).

Minimum criteria: an unrestricted license in each practice state, DEA and state controlled-substance registrations where they apply, current liability insurance, federal-program eligibility and no unexplained work-history gap of six months or more in the past five years. Wait for “final notification of contract execution and credentialing approval” before seeing Prime patients as a network provider. Recredentialing comes at least every three years; an appeal must reach Humana Military within 30 calendar days of the notice that you didn’t meet the criteria. A network provider who bills an unauthorized service faces a penalty of up to 50 percent of the allowable charge.

What is the Wellcare timely filing limit in Florida?

For Wellcare, Centene’s Medicare brand: 180 days from the date of service, or what your contract specifies. Florida claims use payer ID 14163 (59354 is for reporting only), disputes are due within 90 calendar days of the EOP, and recredentialing comes at least every 36 months.

Oscar follows state law’s timeline unless your agreement says otherwise. Whether a contract’s shorter limit or a statute governs a claim is a question for your attorney.

What is the Ambetter payer ID, and does Ambetter credential you separately?

68069, with 180 days to file and 90 to dispute, in or out of network. Ambetter’s manual says a practitioner who already participates with Ambetter Health “in the Medicaid or a Medicare product” won’t be credentialed separately (Sunshine’s Medicaid plans). The Sunshine Health form asks for a W-9 signed within the last 12 months (groups over 50 practitioners add a bulk roster). The signed release can be no older than 120 days; wait for the enrollment confirmation letter before seeing members, report changes within 10 days and recredential every 36 months.

What changed in MultiPlan provider enrollment when the company became Claritev?

The company’s name, not the networks’. MultiPlan Corporation became Claritev Corporation on Feb 17, 2025, and contracts now come from “MultiPlan, Inc., d/b/a Claritev.” Its provider page still lists the PHCS Network (national PPO), the MultiPlan Network (national complementary PPO) and the MultiPlan Medicare Advantage Network. The company isn’t an insurer: insurers, employer plans, Taft-Hartley funds and administrators, its “Clients,” access the networks. A state credentialing form can replace its own if a signed contract comes with it. Claims go to the address on the member’s ID card within 90 days of the service, unless law or your agreement sets another limit; dispute a payment within 180 days of receiving it.

Florida’s s. 627.64731, for physicians licensed under chapters 458, 459, 460, 461 or 466 and physician groups, bars a contracting entity from renting or granting access to their services unless the contract expressly authorizes network rental, and requires a listing of who has access, updated at least every 90 days. What a contract allows is a question for your attorney; the business side is payer contracting.

What do Medicare Advantage network adequacy criteria and audits require of a plan?

Joining Devoted’s or Wellcare’s network is separate from Medicare enrollment; federal rules set each plan’s floor:

• Physicians: written notice of participation rules, adverse decisions and an appeal process; either side gives 60 days’ written notice before a without-cause termination (42 CFR 422.202).
• Credentialing: primary-source license verification; recredentialing at least every 3 years (422.204).
• Network adequacy criteria: 90 percent of beneficiaries in large metro and metro counties, and 85 percent in micro, rural or CEAC counties, within CMS’s time and distance standards for each specialty (422.116).
• Directory: updated within 30 calendar days of receiving your changes (422.120).
• Payment: non-contracted clean claims, 95 percent within 30 days (422.520).

CMS audits and fines the plans: for 2025, 14 civil money penalties for 18 violations, $1.54 million in all. Its audit protocols are CMS-10717; a revised audit process overview is due before the 2027 audits.

What you can do today

1. CAQH (DataSpring): authorize Devoted, Ambetter and Oscar to view your profile (CAQH and NPI).
2. TRICARE: certify in every state you practice in, then ask to join the network only if your specialty is one of the six it takes.
3. Rented networks: physicians can ask each contracting entity to identify every third party granted access to their services, which s. 627.64731(3) requires on request.

Advixor prepares, submits, monitors and follows up credentialing and enrollment applications with commercial plans, Medicare, Medicaid and other applicable payers (payer enrollment).