Get Caqh Provider Data Form Instructions - Sunflower State Health ...

Filling out the Caqh Provider Data Form is essential for credentialing with Sunflower State Health Plan. This guide provides a step-by-step approach to help users complete the form with ease and accuracy.

Follow the steps to effectively complete the Caqh Provider Data Form.

1. Press the ‘Get Form’ button to obtain the CAQH Provider Data Form and open it for editing.
2. If you are registered with CAQH, begin completing the data form provided in this packet by filling out all relevant sections.
3. For those not registered with CAQH, contact Sunflower State Health Plan for a CAQH Application Form. Complete this form before proceeding with the Provider Data Form.
4. In the form, provide your date, CAQH Provider ID (if applicable), and indicate your registration status with CAQH as 'Yes' or 'No.'
5. Fill in personal details including social security number, last name, first name, date of birth, individual NPI, provider type, and Medicaid ID number.
6. Indicate whether you are a hospital-based provider not practicing in an office setting.
7. Specify the specialties you are requesting for participation in the health plan using NPI taxonomy codes.
8. Complete the practice name, email address, primary office address (including suite number, city, state, county, zip code), primary telephone and fax numbers.
9. Provide credentialing contact information and indicate if you are applying as a specialist or primary care physician. If a primary care physician, specify if you are accepting new patients and any restrictions.
10. Answer questions about board certification, ownership of medical-related organizations, and direct laboratory services if applicable.
11. Finally, review all information for accuracy, then save your changes. You can choose to download, print, or share the completed form based on your needs.

Complete your Caqh Provider Data Form online today to ensure proper credentialing with Sunflower State Health Plan.