Provider Networks
PROVIDERS LOGIN TO THE PROVIDER PORTAL HERE
Gateway Health maintains a proprietary network of physicians and facilities. Our in-house Provider Relations department will work with members and the providers they utilize to ensure no gaps in network coverage.
All practitioners applying for participation in the Gateway Health Alliance network must meet the credentialing criteria, unless an exception is made by the Credentialing Committee.
All practitioners applying for initial and continued participation in the Gateway network must also meet all applicable criteria as outlined below:
- Have a current Gateway Health contract.
- Have completed a Credentialing Application or a CAQH Provider Data Form and a current attestation statement.
Have current, unrestricted state license in Virginia, and/or North Carolina. - Be Board Certified in the primary specialty for which the physician in applying. The acceptance of a non-board certified physician might occur when it is determined.
- No board certified physicians are available or other exceptions of waiver requirements are met.
- Board Certification was not available at the time the physician entered practice.
At the time of recredentialing, PCPs must perform adequately when information pertaining to member complaints, member satisfaction, utilization management, and/or results of quality improvement activities are evaluated.
Gateway re-credentials providers every three years. We verify that the physician has a current medical license, active medical malpractice coverage, hospital privileges, and board certification. Medical malpractice claims filed during the last three years are reviewed. Quality Improvement issues, Utilization Management issues, and member complaints are also considered during this process. Decisions about re-credentialing are made by Gateway’s Medical Management Committee.
Affirmative Statement
Gateway Health employees make clinical decisions regarding health care based on the most appropriate care and service available. We do not reward providers or other employees for any denials of service. We also do not encourage nor reward clinical decisions that result in decreased services.
In addition, Gateway Health does not use incentives to encourage barriers to care and service. We prohibit any employee or representative of Gateway Health from making decisions regarding hiring, promotions, or termination of providers or other individuals based upon the likelihood or perceived likelihood that the individual or group will support or tend to support the denial of benefits.
Network Management
Gateway Health provides executive management and certain staffing functions for three other provider networks in Virginia, as well. These are:
- Halifax Physician Hospital Organization (HPHO) in South Boston, VA
- Valley Health Plan (VHP) in Harrisonburg, VA
- Martha Jefferson Physician Hospital Organization (MJPHO) in Charlottesville, VA
Important Notice
Piedmont Community Health Plan
You may know that Piedmont Community Health Plan (PCHP) will cease operations on December 31, 2024. For the remainder of 2024, PCPH will continue to conduct business as usual, with all practices remaining covered under its plan. Gateway Health only utilizes PCHP for their network. In preparation for the transition, Gateway Health is actively collaborating with all sole PCHP contracted practices to ensure continued inclusion in the Gateway network in 2025, with minimal disruptions.
What you can expect now and in the future:
- Healthgram/Gateway Health is still your insurance company.
- There will be no change in health coverage or pharmacy benefits.
- The same level of customer service and expertise that you are accustomed to will continue.
Questions:
Call Gateway Health Client Services Department 434.799.3838, Option 0
Available forms:
Gateway Additional Provider Information Request Form
HPHO Additional Provider Information Request Form