REQUIRED DOCUMENTS

What documents are needed for insurance credentialing?

Document needs vary based on the type of provider and insurance plan.  Here are a list of base documents that may be needed:

Core Documents for an individual Provider setup:

1. Practitioner License(s)
2. Malpractice Insurance (Certificate of Insurance)
3. DEA (federal) and state CDS certificates
4. Board Certification(s)
5. Diploma – copy of highest level of education (required for non-MD’s,DO’s)
6. Current CV (showing current employer, and all entries have mm/yy format)
7. IRS Form W-9
8. Current driver’s license

Other documents that may be applicable:

1. ECFMG Certificate (if educated outside of The United States)
2. Passport or other citizenship documents (if born outside U.S. and not previously enrolled in Medicare)
3. Collaborative Agreement (required for Nurse Practitioners)
4. Admitting Arrangement letter (required for providers who do not have hospital admitting privileges)
5. Prescribing arrangement letter for providers not holding DEA certificate

Legal Company Document Requirements:

1. IRS form CP575 or replacement letter 147C (verification of EIN)
2. Business License
3. CLIA Certificate
4. Copy of office lease (required for therapy facilities)
5. Letter of bank account verification (for Medicare enrollment)
6. EFT/ERA – Banking & Routing number information for setup