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Credentialing Application for Hospitals and Facilities

Credentialing Application for Hospitals and Facilities 2025

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The document is a Credentialing Application for practitioners, outlining the necessary steps and information required for applicants seeking participation in the HWMG Provider Network. It includes instructions for completing the application, sections for personal and professional details, licensure, education, clinical history, malpractice disclosures, and an authorization release. The application must be completed accurately and submitted to the HWMG Credentialing Department, with a processing time of up to 60 days.

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Click ‘Get Form’ to open the Credentialing Application in the editor.
Begin by filling out your personal information, including your last name, first name, date of birth, and gender. Ensure all fields are completed accurately.
Proceed to the Credentialing Contact Information section. Provide details such as your preferred method of contact and office address. If any field does not apply, mark it as 'N/A'.
In the Professional License section, list all relevant licenses along with their issue dates and expiration dates. Attach additional sheets if necessary.
Complete the Specialty/Sub-Specialty Board Certification section by indicating your primary specialty and certifying board. If you are not board certified, provide an explanation.
Sign and date the Authorization, Attestation, and Release on page 6 before submitting your application.

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Versions	Form popularity	Fillable & printable
2022	4.5 Satisfied (46 Votes)
2018	4.8 Satisfied (97 Votes)
2018	4.3 Satisfied (65 Votes)
2016	4.2 Satisfied (24 Votes)

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What is a credentialing application?

- 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 are the three types of credentialing?

What is an Example of Credentialing? Professional Credentialing. Facility Credentialing. Payer Enrollment Credentialing.

How do I credential a facility?

Facility Credentialing The provider is in good standing with state and federal regulatory bodies. The provider has been reviewed and approved by an accrediting body. The provider has had an on-site visit by either DOH/DHS or CMS within the past 36 months if not accredited.

Which form of professional credentialing is considered the most restrictive?

Licensure tends to be the most restrictive form of professional regulation; it often is referred to as right-to-practice.

What is the hospital credentialing process?

Credentialing is a formal process that utilizes an established series of guidelines to ensure that patients receive the highest level of care from healthcare professionals who have undergone the most stringent scrutiny regarding their ability to practice medicine.

What comes first credentialing or privileging?

Hospitals and other health care employers and payers both have credentialing processes to complete. Credentialing is closely tied with privileging and is frequently a first step for physicians seeking hospital privileges.

What are the two types of credentialing?

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

What is the credentialing process in healthcare?

Credentialing is a vital process for healthcare institutions. In simple terms, it is the process of assessing a healthcare providers academic qualifications and clinical practice history.

Credentialing Application for Hospitals and Facilities 2025

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