Get the free Regence BlueCross BlueShield of Utah Practitioner Credentialing Application
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This application is designed for healthcare providers seeking credentialing with Regence BlueCross BlueShield of Utah, requiring comprehensive information about the provider's qualifications, practice
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How to fill out Regence BlueCross BlueShield of Utah Practitioner Credentialing Application
01
Download the Regence BlueCross BlueShield of Utah Practitioner Credentialing Application from their website.
02
Fill out your personal information, including your full name, contact details, and date of birth.
03
Provide your professional information, such as your medical license number, specialty, and board certifications.
04
Enter details of your education and training, including medical school, residency, and any fellowships completed.
05
List your work history, including all relevant employment and practice locations over the past five years.
06
Include references from colleagues or employers who can vouch for your practice.
07
Complete the section regarding malpractice claims or disciplinary actions, if applicable, ensuring honesty and accuracy.
08
Review the application for any missing information or errors.
09
Sign and date the application to certify that the information provided is true.
10
Submit the completed application along with any necessary supporting documents as instructed by Regence.
Who needs Regence BlueCross BlueShield of Utah Practitioner Credentialing Application?
01
Healthcare practitioners such as physicians, nurse practitioners, and physician assistants who wish to participate in the Regence BlueCross BlueShield of Utah network.
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What is Regence BlueCross BlueShield of Utah Practitioner Credentialing Application?
The Regence BlueCross BlueShield of Utah Practitioner Credentialing Application is a formal document that healthcare practitioners must complete to obtain credentialing for participation in the Regence BlueCross BlueShield network. It collects essential information regarding the practitioner's qualifications, experience, and professional background.
Who is required to file Regence BlueCross BlueShield of Utah Practitioner Credentialing Application?
All healthcare practitioners who wish to participate in the Regence BlueCross BlueShield of Utah network are required to file the Practitioner Credentialing Application. This includes physicians, nurse practitioners, and other allied health professionals.
How to fill out Regence BlueCross BlueShield of Utah Practitioner Credentialing Application?
To fill out the application, practitioners should gather their professional qualifications, education, licenses, certifications, malpractice history, and any other relevant documents. They must carefully follow the instructions provided in the application form, ensuring that all sections are completed accurately before submitting it.
What is the purpose of Regence BlueCross BlueShield of Utah Practitioner Credentialing Application?
The purpose of the application is to evaluate the qualifications and professional credibility of healthcare practitioners seeking to join the Regence BlueCross BlueShield network. It ensures that only qualified individuals are allowed to provide care to members.
What information must be reported on Regence BlueCross BlueShield of Utah Practitioner Credentialing Application?
The application requires information such as the practitioner's full name, contact details, education, medical training, board certifications, work history, malpractice claims history, disciplinary actions, and any other relevant professional details.
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