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Opca credentialing application ca 2009 form

Opca credentialing application ca 2009 form-2025

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The document is the Regence BlueCross BlueShield of Oregon Practitioner Credentialing Application, which outlines the process for healthcare professionals to apply for credentialing to join provider networks. It details the requirements for application submission, including necessary documentation and steps for verification. The application includes sections on personal information, education, professional history, and attestation questions regarding licensure and professional conduct. Additionally, it emphasizes compliance with credentialing criteria and provides instructions for electronic submission.

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Click ‘Get Form’ to open the opca credentialing application ca 2009 form in the editor.
Begin by entering your personal information in Section II, including your full legal name, contact details, and social security number. Ensure all fields are filled accurately.
Proceed to Section III to provide your specialty information. Indicate your principal clinical specialty and any additional specialties you wish to list.
In Section IV, detail your board certifications. Attach additional sheets if necessary for comprehensive coverage of all certifications.
Complete Sections V through XXI as applicable, ensuring that you provide all required supporting documentation and sign where indicated.
Once completed, use the platform's features to save and print the application. Sign pages 11 and 12 before submitting via email or fax as instructed.

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Versions	Form popularity	Fillable & printable
2012	4.9 Satisfied (325 Votes)
2009	4 Satisfied (44 Votes)
2004	4 Satisfied (24 Votes)

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