Ancillary and Facility Provider Credentialing Application: Fill out & sign online

Here's how it works

01. Edit your form online

Type text, add images, blackout confidential details, add comments, highlights and more.

02. Sign it in a few clicks

Draw your signature, type it, upload its image, or use your mobile device as a signature pad.

03. Share your form with others

Send it via email, link, or fax. You can also download it, export it or print it out.

How to modify Ancillary and Facility Provider Credentialing Application online

Ease of Setup

DocHub User Ratings on G2

Ease of Use

DocHub User Ratings on G2

With DocHub, making adjustments to your paperwork takes only a few simple clicks. Follow these quick steps to modify the PDF Ancillary and Facility Provider Credentialing Application online free of charge:

Register and log in to your account. Sign in to the editor with your credentials or click Create free account to examine the tool’s features.
Add the Ancillary and Facility Provider Credentialing Application for editing. Click on the New Document option above, then drag and drop the sample to the upload area, import it from the cloud, or using a link.
Modify your template. Make any adjustments needed: add text and photos to your Ancillary and Facility Provider Credentialing Application, highlight details that matter, erase parts of content and substitute them with new ones, and add icons, checkmarks, and areas for filling out.
Finish redacting the form. Save the updated document on your device, export it to the cloud, print it right from the editor, or share it with all the people involved.

Our editor is very easy to use and effective. Give it a try now!

be ready to get more

Complete this form in 5 minutes or less

Get form

Got questions?

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

Contact us

What is credentialing and privileging process?

Credentialing is "the process of assessing and confirming the license or certification, education, training, and other qualifications or a licensed or certified healthcare practitioner." Privileging is "the process of authorizing a health care practitioner's specific scope and content of patient care services."

What does a credentialing system do?

For hospitals and healthcare systems, credentialing initiates the gathering of data that will be used eventually for both clinical privilege delineation and enrolling providers into payer panels, so the organization can be reimbursed for services.

What is facility credentialing?

What is Facility Credentialing? Facility credentialing is the process by which a health plan (insurance company) evaluates and then approves a facility to be \u201cin network\u201d with them and a participating provider of specific healthcare services. Don't confuse a facility with a group practice.

What are the three main types of credentialing?

At the individual level, there are three categories of credentialing: (1) the initial licensure for entry into practice; (2) certifications of specialized skills or training within the scope of the basic professional license, such as certification of critical care nursing or oncology nursing; and, (3) licensure for ...

What is a credentialed practitioner?

In healthcare, physician credentialing is the process of organizing and verifying the professional records that qualify a doctor to practice medicine. This includes their board certifications, hospital admitting privileges, education, malpractice insurance, professional references, work history, and more.

Related forms

be ready to get more