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. Medi-Cal # required Addendum D PPMC Provider Rights/Responsibilities form Addendum E, Provider Care Experience, completed, signed and dated Addendum F, HIV Attestation, Only applicable for Internal Medicine and Infectious Disease Provider Addendum G, PPMC Provider Work History Form or Page 6 of the Application (Explanation for any gap of 6 months or greater)(Document dates at mm/yyyy).
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 …
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