Get the free organizational provider credentialing application 2012 form

ORGANIZATIONAL PROVIDER CREDENTIALING APPLICATION TYPE OF ORGANIZATION Ambulatory Surgery Center Home Health Agency Hospital Skilled Nursing Facility/Nursing Home Durable Medical Equipment Rural Health Clinic Home Infusion Other Inpatient Facility DEMOGRAPHIC INFORMATION Facility Name Address City State Zip Phone On-Call Phone Fax Contact Person Email Tax ID number NPI number Taxonomy Code CREDENTIALING CONTACT INFORMATION Name Email LICE...

How to fill out organizational provider credentialing application

How to fill out organizational provider credentialing application:

1. Begin by gathering all necessary documentation such as educational certificates, work history, licenses, and certifications.
2. Review the application form thoroughly to understand the required information and any supporting documents needed.
3. Start filling out the application form by providing accurate personal information, including name, contact details, and social security number.
4. Provide a detailed work history, including dates of employment, job titles, and duties performed for each organization.
5. Include information about your educational background, such as degrees earned, institutions attended, and dates of graduation.
6. Fill out any sections related to certifications or licenses held, ensuring you provide accurate details and dates of expiration.
7. Provide references from previous employers or professional colleagues who can vouch for your skills and qualifications.
8. Review the completed application form for any errors or missing information before submitting it.
9. Gather all required supporting documents and attach them to the application form.
10. Submit the completed application and documentation to the appropriate authority or organization.

Who needs organizational provider credentialing application?

1. Healthcare professionals who wish to provide services within an organized healthcare setting.
2. Providers seeking to participate in health insurance networks or government-funded healthcare programs.
3. Healthcare organizations requiring providers to undergo a credentialing process for quality assurance and patient safety purposes.

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What is organizational provider credentialing application?

The organizational provider credentialing application is a document that organizations must submit to apply for credentials as a provider in a specific healthcare network or insurance program.

Who is required to file organizational provider credentialing application?

Any organization that wants to become a provider in a healthcare network or insurance program is required to file an organizational provider credentialing application.

How to fill out organizational provider credentialing application?

To fill out the organizational provider credentialing application, you will need to provide detailed information about your organization, such as legal name, address, contact information, services offered, qualifications of providers, and any certifications or accreditations held.

What is the purpose of organizational provider credentialing application?

The purpose of the organizational provider credentialing application is to assess and evaluate the qualifications, capabilities, and compliance of organizations who wish to become providers in a healthcare network or insurance program.

What information must be reported on organizational provider credentialing application?

The organizational provider credentialing application typically requires information such as organization's legal name, address, contact details, services offered, qualifications of providers, certifications or accreditations held, and any relevant supporting documentation.