Apply for Credentialing

Credentialing Instructions

Skilled Nursing Facilities

Dear Health Care Provider: Private Duty Nursing

The following instructions will help you understand the information required to credential your Skilled Nursing 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.

Accredited Skilled Nursing Facilities:

  • A completed signed and dated application for each site and each organization with a unique TAX ID# is a required legal document.
  • If not accredited, please provide a copy of the most recent CMS Review. 
  • If you are qualified and enrolled with the National Supplier Clearinghouse as a Medicare certified DMEPOS supplier one of the following accreditation certificates is needed:
    • The American Board of Certification (ABC)
    • The Board of Certification/Accreditation International (BOC)
    • Commission on Accreditation of Rehabilitation Facilities (CARF)
    • Community Health Accreditation Program (CHAP)
    • HealthCare Quality Association on Accreditation (HQAA)
    • National Association of Boards of Pharmacy (NABP)
    • The Joint Commission (JCAHO)
    • The Compliance Team, Inc.
    • The National Board of Accreditation for Orthotic Suppliers (NBAOS)
    • Accreditation Commission for Health Care, Inc. (ACHC)
  • Copy of the Division of Health Service Regulation license
  • A general liability malpractice insurance face sheet must include current coverage dates, provider name, address, and limits of coverage. Minimum coverage for all networks is $1 million occurrence/$3 million aggregate.
  • Medicare verification is required for each site (or letter attesting to all covered sites).
  • 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. For Initial Credentialing will also accept letter of certification from Medicare and Medicaid.  
  • If the provider is not currently accredited and answers yes to any questions on the application under section 1.G, an explanation is needed. The following information is required if question number C is answered yes:
    • Number of cases less than $200,000
    • If greater than $200,000 actual or anticipated, include the occurrence date, settlement date, and nature of case.

Get Acrobat To view PDF documents you need Adobe Acrobat Reader.