Provider Credentialing in District of Columbia

The District of Columbia presents a unique credentialing environment as a non-state jurisdiction with high provider density, major federal employer presence (including VA and federal civilian employees covered by FEHB plans), and a patient population that spans the DC-Maryland-Virginia tri-state area. Many DC providers also maintain Maryland and Virginia licenses, and credentialing with CareFirst BlueCross BlueShield — which covers all three jurisdictions — is the single most important credentialing relationship in the greater DC market.

CareFirst BlueCross BlueShield is the dominant commercial insurer for the DC metro area, covering Maryland, DC, and Northern Virginia under a single regional license. Kaiser Permanente Mid-Atlantic has a significant HMO enrollment in DC and the surrounding area. Aetna and United Healthcare serve primarily federal employee (FEHB) markets, which are particularly important in DC given the concentration of federal government agencies and contractors.

DC Medicaid operates managed care primarily through AmeriHealth Caritas DC and MedStar Family Choice (a MedStar Health affiliated plan). The DC HealthCare Alliance covers uninsured residents who are ineligible for Medicaid. DC expanded Medicaid under the ACA and has among the highest Medicaid enrollment rates relative to population in the country.

Arctic Health helps DC providers credential with CareFirst for the tri-state market, FEHB plans for federal employee populations, and all DC Medicaid managed care plans, managing what is one of the most complex multi-jurisdiction credentialing environments in the country.