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Credentialing request form template

Credentialing request form 2025

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The document is a Credentialing Request Form from DaVita, designed for individuals or organizations to request credentialing for healthcare practitioners. It includes sections for requestor information, practitioner demographics, practice information, and facility requests. The form allows users to add or remove facilities from a practitioner's profile and provides contact details for various credentialing coordinators based on state.

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What is a credentialing request?

- 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 evaluated in the credentialing process?

Effective credentialing in healthcare entails a comprehensive evaluation of providers education, training, licensure, experience, and adherence to professional standards and regulations.

What is a credentialing check?

Defining 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.

What is checked during a credentialing process?

The physician supplies the information required, including contact information, current CV, education and training history, licensing and certificates, medical group and hospital affiliations, Board certifications, sanctions or malpractice history, proof of liability insurance and peer references.