Transcription of Initial Credentialing Application Checklist
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Initial Credentialing Application Checklist
Initial Credentialing Application Checklist If you are a CAQH (Council for Affordable Quality Healthcare) provider please provide your CAQH number CAQH#: _____ California Participating Physician Application (CPPA) P lease ensure the entire Application is completed in its entirety and the Attestation Questions page and Information Release/Acknowledgements page has a current date Addendum A, completed, signed and dated Addendum B, completed, signed and dated. Attach copies of malpractice claims history and explanation in the providers own words, if applicable Addendum C Provider Health History, completed, signed and dated.
Initial Credentialing Application Checklist . If you are a CAQH (Council for Affordable Quality Healthcare) provider please provide your CAQH number . CAQH#: _____
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