Definition of a Clean and Complete Credentialing Application

A complete application shall include:

• An application that is signed and appropriately dated by the provider applicant (CAQH application)
• Complete and legible information (Completed CAQH application should meet this requirement)
• Explanations that are satisfactory to the health plan, to any affirmative answer
• A current CV with appropriate required dates in months and years (Accurate and complete education & work history info in CAQH should meet this requirement)
• A signed, currently dated Applicant’s Authorization to Release Information form (Part of CAQH application)
• If practitioner is to have a current federal DEA controlled substance certificate or state Controlled Substance Registration but is not available, a letter describing prescribing arrangements (s.a., DEA still has out of state address)
• Hospital letter or verification of hospital credentialing (or alternative pathways), as required
• A copy of current malpractice face sheet coverage statement indicating name of insurer, amounts and dates of coverage (Accurate and complete malpractice insurance section in CAQH application should meet this requirement)
• Documentation of board certification (or alternative pathways)
• Documentation of training (if not Board-certified)
• No affirmative responses on questions related to quality or clinical competence
• No modifications to Applicant’s Authorization to Release Information form
• No discrepancies between physician-provided information and information received from other sources
• Appropriate health plan participation agreement(s), if applicable
• W-9 (Can be sent to CAQH as part of scanned documents. This also can be sent with health plan participation agreement(s)