Apply for Credentialing
Home Durable Medical Equipment (This includes all Home Durable Medical Equipment which will include equipment only and cardiac event monitoring only)
Dear Health Care Provider:
The following instructions will help you understand the information required to credential your Home Durable Medical Equipment facility. To avoid delays associated with an incomplete credentialing application, please review this material carefully before attempting to complete the application. Fill in all required information completely and attach all required documents before submitting your application.
Upon completion of the credentialing process, your application will be presented to the Credentialing Committee for approval or denial. If denied you will be notified by certified mail. If approved, Network Management will contact you to finalize the contracting process and assign your effective date.
ALL APPLICANTS: Please note all fields must be COMPLETED or indicate NOT APPLICABLE (NA). All supporting required documents must be submitted or the application cannot be processed and will be returned.
- A completed signed and dated application for each site and each organization with a Unique Federal Tax ID# is a required legal document.
- A copy of the North Carolina Division of Health Service Regulation or North Carolina Board of Pharmacy Permit-Devise Dispensing Permit, Board of Pharmacy Permit-Devise and Medical Equipment Permit is required.
- One of the following documents is needed:
- Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
- The Community Accreditation Program, Inc. (CHAP)
- Accreditation Commission for Health Care (ACHC)
- The Compliance Team Inc.'s "Exemplary Provider Award Program,"
- Commission on Accreditation of Rehabilitation Facilities (CARF)
- Healthcare Quality Association on Accreditation (HQAA)
- National Association of Boards of Pharmacy (NABP)
- The National Board of Accreditation for Orthotic Suppliers (NBAOS)
- American Board of Certification in Orthotics and Prosthetics (ABC)
- Board of Certification/Accreditation International (BOC)
- Medicare/Medicaid verification is needed for each site (or letter attesting to all covered sites) if applicable.
Note: A current copy of the Medicare and Medicaid Remittance Advice Summary (RA) from the facility will meet this criterion.
Note: If applying for the lue Medicare HMO and Blue Medicare PPO networks Medicare certification is required.
- A general liability malpractice insurance face sheet is required for each site (or letter attesting to all covered sites), and must include current coverage dates, provider name, address and limits of coverage. Minimum coverage for all networks is $1 million occurrence/$3 million aggregate.