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HMSA Facility and Ancillary Credentialing Application

HMSA Facility and Ancillary Credentialing Application 2025

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The document is a comprehensive Behavioral Health Facility and Ancillary Credentialing Application that outlines the requirements and necessary documentation for facilities seeking credentialing with Superior HealthPlan. It includes a checklist of required forms, licenses, insurance information, and details about facility operations. The application must be completed thoroughly for initial credentialing or recredentialing, and it specifies the need for separate applications for each facility with a unique Federal Tax ID.

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Click ‘Get Form’ to open the HMSA Facility and Ancillary Credentialing Application in the editor.
Begin by filling out the 'Facility Practice Locations' section. Indicate whether this is for initial credentialing, adding a new site, or recredentialing. Provide the legal name, parent company, and facility type.
Complete the 'Identify Levels of Care Offered by Facility' section. Select all applicable levels of care and specify if detoxification services are offered.
In the 'Facility Information' section, provide your mailing address, administrative phone number, and federal tax ID number. Ensure all contact information is accurate.
Attach required documents such as accreditation letters, licenses, and insurance policies as specified in the checklist provided within the application.
Review all entered information for accuracy before submitting. Use our platform's features to sign and send your completed application via email or mail as instructed.

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Versions	Form popularity	Fillable & printable
2019	4.8 Satisfied (106 Votes)
2016	4.3 Satisfied (68 Votes)

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We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What are the two types of credentialing?

Types of credentialing Personal Credentialing. Political Credentialing. Paperless Credentialing.

What are credentialing applications?

- A credentialing process is utilized by health care facilities as part of its process to allow practitioners to. provide services on its campus, health plans to allow providers to participate in its network (provider enrollment), and other health care entities that have a need to hire or otherwise engage providers.

What is the difference between credential and enrollment?

Required Information: Provider credentialing focuses on the providers education, training, and licensure. Provider enrollment requires most of this information in addition to information regarding their employment terms and practice location.

How long does each credentialing application take?

The general timeframe for healthcare providers to complete credentialing is between 90 to 120 days. However, this is an average estimate. Some payors may complete the process quicker, while others might take longer, especially for certain specialties.

What is the difference between credentialing and provider enrollment?

Provider enrollment is distinct from credentialing, although the two processes are often interrelated. While credentialing focuses on verifying the qualifications and competence of the provider, enrollment is about establishing the providers eligibility to bill a particular payer.

Is payer enrollment licensing or credentialing?

While credentialing is the process to certify a providers qualifications to practice medicine, payer enrollment is the process of requesting participation in a health plan network, including commercial payers such as Humana and Aetna and government programs such as Medicare and Medicaid.

HMSA Facility and Ancillary Credentialing Application 2025

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