Get Az Ahp Facility Credentialing & Recredentialing Application Form 2020-2025

Completing the AZ AHP Facility Credentialing & Recredentialing Application Form online can streamline your submission process. This guide provides step-by-step instructions to ensure that you provide the necessary information accurately and completely.

Follow the steps to successfully complete the application form.

1. Click the ‘Get Form’ button to obtain the form and open it in your preferred online editor.
2. Begin by selecting the type of facility you are applying for from the list provided. Ensure that you choose the correct option to reflect your facility’s classification.
3. Fill in the facility demographics section thoroughly. This includes the legal business name, federal tax identification number, and any doing business as (dba) names, among other necessary details.
4. Provide the primary location of your facility, including the street address, city, state, zip code, and contact information. Make sure to attach a copy of the state license or business license.
5. Indicate whether your facility is Medicare certified by checking the appropriate box and provide the Medicare number and AHCCCS/Medicaid number if applicable.
6. Complete the accreditation section by indicating if your site has been reviewed by any accrediting authorities and attach the most recent accreditation report as required.
7. Respond to the disclosure questions. Carefully check the applicable boxes and provide detailed descriptions on separate sheets for any 'Yes' answers.
8. Complete the facility attestation/consent and release form by providing your name, title, signature, and date. Ensure all information is accurate to avoid processing delays.
9. Review the application thoroughly to ensure all sections have been completed and required documentation is attached. Pay special attention to legibility and completeness.
10. Once you have double-checked your application, save your changes, and download or print the completed form for submission.

Start filling out your documents online today to ensure timely processing.