HI AlohaCare Provider Credentialing Application 2017 free printable template
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PROVIDER CREDENTIALING APPLICATION Thank you for your interest in contracting with AlohaCare to serve our AlohaCare Quest Integration and AlohaCare Advantage HMO SNP members. Providers must be credentialed by AlohaCare prior to rendering care or services to AlohaCare members. Attach extra pages if necessary If individual or organization is associated with a Hawaii Medicaid List the name title FEIN/SSN and business address of all managing employees below as defined in 42 CFR 455. THIS FORM IS...
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How to fill out HI AlohaCare Provider Credentialing Application
How to fill out HI AlohaCare Provider Credentialing Application
01
Download the HI AlohaCare Provider Credentialing Application from the AlohaCare website.
02
Fill out the personal information section, including your name, contact details, and social security number.
03
Provide details about your professional background, including education, training, and experience.
04
List your current and past licenses, certifications, and accreditations relevant to your practice.
05
Document your malpractice history, including any claims or settlements.
06
Include any disciplinary actions taken against your licenses or certifications.
07
Attach copies of all relevant documents such as licenses and certificates.
08
Review the application carefully for completeness and accuracy.
09
Sign and date the application.
10
Submit the application to the appropriate AlohaCare credentialing office as instructed.
Who needs HI AlohaCare Provider Credentialing Application?
01
Healthcare providers who wish to participate in the AlohaCare network.
02
New providers seeking to establish their credentials with AlohaCare.
03
Existing providers seeking to update their credentials or renew their status with AlohaCare.
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What is HI AlohaCare Provider Credentialing Application?
The HI AlohaCare Provider Credentialing Application is a formal document used by healthcare providers to apply for credentialing within the AlohaCare health plan, ensuring that they meet the required standards and qualifications.
Who is required to file HI AlohaCare Provider Credentialing Application?
Healthcare providers, including physicians, specialists, and ancillary providers, who wish to participate in the AlohaCare health plan are required to file the HI AlohaCare Provider Credentialing Application.
How to fill out HI AlohaCare Provider Credentialing Application?
To fill out the HI AlohaCare Provider Credentialing Application, providers need to provide accurate personal and professional information, including licensing details, education history, work experience, and any relevant certifications. The application must be completed in full and all required documents should be submitted along with it.
What is the purpose of HI AlohaCare Provider Credentialing Application?
The purpose of the HI AlohaCare Provider Credentialing Application is to verify the qualifications, background, and competency of healthcare providers before they are allowed to deliver services under the AlohaCare health plan, ensuring patient safety and adherence to regulatory standards.
What information must be reported on HI AlohaCare Provider Credentialing Application?
The HI AlohaCare Provider Credentialing Application must report information such as provider identification details, licensing and certification information, malpractice history, work history, education background, and any ongoing legal or disciplinary actions.
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