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Mutual of omaha provider credentialing

Physician credenditaling forms 2026

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The document is a credentialing and recertification application for healthcare organizations and facilities. It outlines the required documents, such as accreditation certificates, state licenses, DEA certificates, and liability insurance details. The application includes sections for organizational information, licensure status, Medicare certification, and questions regarding compliance with healthcare regulations. Additionally, it emphasizes the importance of accurate information and consent for evaluation by Premera Blue Cross.

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Click ‘Get Form’ to open the physician credentialing application in the editor.
Begin by filling out the 'Organization/Facility' section. Enter the name, facility type, complete address, city, state, zip code, phone number, and fax number accurately.
Provide your Federal Tax ID Number and NPI Number. Ensure that these numbers are current and valid.
Complete the contact person details including their name, phone number, fax number, and email address for communication purposes.
Indicate whether your facility provides language translation/interpreter services by selecting 'Yes' or 'No'.
Fill in the licensure information including your license number and confirm if it is in good standing with the state.
If applicable, provide your Medicare certification status and DEA number. Make sure to check if they are in good standing.
Attach required documents such as liability insurance face sheets or accreditation certificates as specified in the form.
Answer all questions regarding procedures for patient errors and any criminal offenses related to healthcare honestly.
Review all entered information for accuracy before submitting your application through our platform.

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Versions	Form popularity	Fillable & printable
2014	4.8 Satisfied (268 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.

Can I do my own credentialing?

Almost all insurance companies use the information in there to vet new network applicants. Credentialing is entirely doable on your own, decide which insurance companies you want to credential with (ie, which ones pay the best, which have the most subscribers in your area) and go from there.

What is meant by provider credentialing?

Provider credentialing in healthcare refers to the process of verifying and evaluating the qualifications, credentials, and background of healthcare providers, such as physicians, nurses, and other allied healthcare professionals, before allowing them to provide care to patients.

Is being a credentialing specialist hard?

While there are no formal education requirements to become a credentialing specialist, most earn an associate or bachelors degree in medical terminology, health information management, healthcare administration, or a related field.

Is it hard to be a credentialing specialist?

A credentialing specialist role requires quite a specific set of skills and qualifications - this isnt the type of job you can just walk into. Credentialing ensures patients receive the highest level of care through stringent evaluation of healthcare professionals.

How much does a credentialing specialist make in the US?

A typical day for an Entry Level Credentialing Specialist involves reviewing and verifying professional credentials, updating and maintaining databases, and ensuring all documents are compliant with organizational or regulatory standards.

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What do I need to be a credentialing specialist?

The average salary for a credentialing specialist is $24.92 per hour in the United States. 1.9k salaries taken from job postings on Indeed in the past 36 months (updated September 13, 2025).

What are the two types of credentialing?

The two main types of credentialing are: Primary Source Credentialing. This involves verifying qualifications, licenses, certifications, education, and other credentials directly from the original source, such as universities, licensing boards, or professional organizations. Secondary Credentialing.

Physician credenditaling forms 2026

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