Get Sandhills Center Uniform Re-credentialing Application To Participate As A Health Care Practitioner 2018-2025

The Sandhills Center Uniform Re-Credentialing Application is essential for practitioners seeking reimbursement for services provided to Sandhills Center members. This guide will provide you with clear, step-by-step instructions on completing the application online, ensuring that you meet all requirements.

Follow the steps to complete your online application effectively.

1. Press the ‘Get Form’ button to access the Sandhills Center Uniform Re-Credentialing Application.
2. Begin filling out Section 1, which requires your demographic and personal data such as your name, credentials, date of birth, and place of birth. Ensure that all fields are completed accurately to avoid invalidation of your application.
3. In Section 1, specify your type of practice and the populations you treat. Make sure to address each sub-question regarding language spoken, accepting new patients, and facility accessibility.
4. Move to Section 2, detailing your practice history. List your work history over the last five years and provide explanations for any gaps longer than six months.
5. Proceed to Section 3, answering a series of professional information questions about your licensure, disciplinary actions, and insurance coverage. If answering ‘yes’ to any question, be prepared to complete the attached supplemental form.
6. In Section 4, include information regarding your ownership interests and partners, if applicable. This includes listing any organizations where you hold a control interest.
7. Attach any required documentation such as copies of licenses, certifications, and insurance details as specified throughout the application.
8. Complete and sign the attestation statement at the end of the application. Confirm all information is accurate and that you authorize Sandhills Center to verify your details.
9. Review the entire application for completeness and accuracy. Use the ‘Print’ option to keep a copy for your records before submission.
10. Submit your application and all attached documents to the address provided in the instructions, making sure to keep a vested interest in the process until you receive confirmation.

Ensure your application is completed fully and accurately to participate in the Sandhills Center network. Start your application process online today!