Provider Credentialing in Vermont | Arctic Health

Vermont has the most innovative healthcare payment landscape in the country, operating under a unique All-Payer Model (APM) approved by CMS that aligns Medicare, Medicaid, and commercial payer payment systems through OneCare Vermont, an Accountable Care Organization. This makes Vermont credentialing distinct — providers must understand the ACO structure in addition to traditional payer credentialing to optimize revenue under value-based care arrangements.

Blue Cross Blue Shield of Vermont is the dominant commercial carrier with a market share that makes it the top credentialing priority. MVP Health Care has Vermont commercial enrollment particularly in the Burlington and central Vermont areas. Both plans participate in the Vermont APM through OneCare Vermont.

Vermont Medicaid (Green Mountain Care) is administered by the Department of Vermont Health Access (DVHA) and operates primarily fee-for-service with ACO-aligned care management through OneCare Vermont. Vermont expanded Medicaid under the ACA and has one of the highest Medicaid enrollment rates relative to population in the country. Green Mountain Care enrollment is straightforward compared to multi-MCO states.

Arctic Health helps Vermont providers understand the All-Payer Model implications alongside traditional credentialing with BCBS VT and MVP Health Care, ensuring providers are optimally positioned in Vermont's value-based care landscape.