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DEPARTMENT OF HEALTH SERVICES Division of Quality Assurance F02110C (04/2021) STATE OF WISCONSIN Page 0 of 6 RESIDENTIAL CARE APARTMENT COMPLEX (CAC) NEW PROVIDER CERTIFICATION OR REGISTRATION APPLICATION

How to fill out new provider initial certification

How to fill out new provider initial certification

1. Obtain the necessary forms from the appropriate accreditation agency.
2. Complete all required information on the forms accurately and legibly.
3. Gather any supporting documentation that may be required, such as proof of education or training.
4. Submit the completed forms and documentation to the accreditation agency for review.
5. Await approval and confirmation of your new provider initial certification.

Who needs new provider initial certification?

1. Healthcare professionals who are looking to become providers at a new facility or organization.
2. Individuals who are starting a new healthcare practice and need to be certified as a provider.

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What is new provider initial certification?

New provider initial certification is the process of obtaining certification for a new healthcare provider or facility to participate in a specific healthcare program.

Who is required to file new provider initial certification?

Any new healthcare provider or facility looking to participate in a specific healthcare program is required to file for new provider initial certification.

How to fill out new provider initial certification?

To fill out new provider initial certification, the provider or facility must complete the necessary forms and submit required documentation as outlined by the program guidelines.

What is the purpose of new provider initial certification?

The purpose of new provider initial certification is to ensure that new healthcare providers or facilities meet the necessary requirements to participate in a specific healthcare program.

What information must be reported on new provider initial certification?

New provider initial certification typically requires information such as provider name, contact information, qualifications, licenses, and any other relevant documentation.