Provider Credentialing Checklist Template

One credentialing specialist and one special projects coordinator.

Provider credentialing checklist template. Provider credentialing checklist. Documents date sent missing info date follow up completed by completion of application passport or drivers license photo current state license and dea registration any other state license ama andor primary source verification. Provider network contract and credentialing checklist. Credentialing and contracting checklist.

Please use this checklist to ensure you have all necessary contract and credentialing components to avoid processing delays. Credentialing checklist provider name. Credentialing application checklist in order to proceed contract coordinators must have the following completed documents. Completed w 9 at least one if all practitioners share same tax id caqh provider data form fully completed.

Once you sign up for our services you will receive an invitation to your secure collaboration folder within 24 hours. The following is a sample checklist. Before a provider or organization can bill an insurance carrier the provider must first be credentialed by the carrier. If provider is in caqh please submit per practitioner.

Thank you for your interest in the superior healthplan network shp. Group health incorporated ghi hip health plan of new york hip hip insurance company of new york and emblemhealth services company llc are emblemhealth companies. Credentialing is the process by which a health insurance carrier formally assesses a providers qualifications and competency. Overview and checklist.

In order to ensure that credentialing activities are performed comprehensively and without missing any steps many msps use a paper or computerized checklist of component steps. For ancillary and facility providers. It can also be useful as a checklist for collecting other documents so you have every physicians information in one centralized file. Special thanks to terry wilson bs cpmsm cpcs flaglers director of medical staff services for sharing the facilitys forms featured in this toolbox.

Emblemhealth services company llc provides administrative services to the emblemhealth companies. Provider credentialing checklist here is a downloadable credentialing checklist which has a link to our online form which should be completed for each provider within the group.