Get Psychcare Re Credentialing Form

Completing the Psychcare Re Credentialing Form online is an essential step for practitioners looking to maintain their status within the network. This guide provides detailed, step-by-step instructions for filling out each section of the form, ensuring a smooth and efficient submission process.

Follow the steps to fill out your Psychcare Re Credentialing Form accurately.

1. Click ‘Get Form’ button to obtain the Psychcare Re Credentialing Form and open it in your editing tool.
2. Begin by filling out the 'Practitioner Identification' section. Clearly enter your last name, first name, middle initial, date of birth, and Social Security number. If applicable, include your maiden name.
3. Move to the 'Practice Identification and Tax ID# Used for Claims' section. Provide the required tax identification number and ensure to submit the current W-9 form. Indicate whether your practice has tax-exempt status and attach the determination letter if applicable.
4. In the 'Addresses' section, input your practice site, mailing, and billing addresses. If you have multiple practice locations, select a primary site for communications and provide accurate contact details.
5. Complete the 'Work History' section by submitting an updated curriculum vitae that includes your chronological work history in the format specified.
6. Fill in the 'Languages' section by marking the languages you speak, as listed in the form.
7. Provide your ethnic information and the population(s) served in the relevant sections. Note that these fields are optional.
8. List your specialties in the corresponding section, choosing from the options provided.
9. Complete the 'Current Average Caseload Information' by entering the average number of patients and completed cases per month.
10. Describe your practice coverage plan in the corresponding section, indicating how you will manage referrals during your absence.
11. Fill out the 'Licensure, Medicare, Medicaid, DEA, and UPIN Data' section with your current licensure details and identifiers.
12. Provide your professional liability insurance details, including your current carrier and coverage limits.
13. If applicable, address the malpractice claims history section and answer the questions regarding any claims against you.
14. In the 'Board Certification Status' section, select your certification status as relevant.
15. Complete the attestation section by confirming the accuracy of the information provided and signing the form with your name and date.
16. Finally, ensure you include any additional documentation requested, then save changes, download your completed form, and print or share as necessary.

Start filling out your Psychcare Re Credentialing Form online today to ensure timely recredentialing.