Get Fpn315-bluechoice Medicaid Credentialing Applicationdocx

The FPN315-BlueChoice Medicaid Credentialing Application is a crucial document for individuals seeking to participate in the BlueChoice HealthPlan Medicaid network. This guide provides clear and detailed steps on how to complete the application online, ensuring that all necessary information is accurately provided for a smooth submission process.

Follow the steps to fill out the FPN315 application online.

1. Click the ‘Get Form’ button to obtain the FPN315-BlueChoice Medicaid Credentialing Application and open it in your preferred editor.
2. Begin with Section A, where you will provide your personal and office information. Ensure that you enter your full name, social security number, license type, national provider identifier (NPI), and contact information accurately.
3. Move on to Section B to list your work history for the past five years. Include all employers in reverse chronological order, account for any gaps in employment, and provide explanations if necessary.
4. In Section C, outline your educational profile, detailing your history of education and training. List relevant degrees and certifications.
5. Proceed to Section D, where you will enter your office profile. Specify your practice hours, any additional languages spoken, and accessibility information.
6. In Section E, respond to attestation questions truthfully. Attach any necessary documentation for questions answered as 'yes'.
7. Complete Section F by providing consent. Ensure to read the statements carefully and sign the application in ink. Remember that stamped signatures are not allowed.
8. After reviewing all sections for accuracy, you can save your changes, download the application, and print it for your records. Finally, submit the completed application to the Provider Network Coordinator as instructed.

Start completing your FPN315-BlueChoice Medicaid Credentialing Application online today.