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)