Get Medcost Recredentialing Form

This guide provides clear instructions on how to complete the MedCost Recredentialing Form online. By following the steps outlined below, users can ensure that their application is accurately submitted and meets all necessary requirements.

Follow the steps to fill out the MedCost Recredentialing Form online.

1. To begin, locate and click the 'Get Form' button to access the MedCost Recredentialing Form and open it in your preferred editor.
2. Fill in the applicant's name, including first, middle, and last names. Ensure the accuracy of all provided information.
3. Enter the name of your practice, along with the complete address, phone number, and fax number.
4. Provide your federal tax ID number, email address, and National Provider Identifier (NPI) for identification purposes.
5. Indicate whether you are accepting new patients by selecting either 'Yes' or 'No,' and provide any restrictions if applicable.
6. Complete the section detailing your office hours and arrangements for 24/7 coverage, including the names and addresses of providers sharing calls.
7. In the personal data section (A), input your date of birth (DOB), Social Security number (SS#), and state medical license number.
8. Specify your type of practice (Primary Care or Specialist), including the name and year of your medical school, and your Federal DEA number.
9. Answer whether you are board-certified, including details about the board name and certification year. If board-eligible, provide the specialty.
10. Listing all hospitals where you have privileges is crucial; ensure to provide complete names and addresses.
11. In section B, answer each professional information question truthfully, and provide explanations for any affirmative responses as required.
12. Complete the attestation statement section, sign and date the application, and ensure no photocopies or stamps are used.
13. Finally, gather and attach the required documents, such as your current board certificate, liability information, specialty board certificate, and the current DEA certificate.
14. After reviewing all filled sections for accuracy, save changes, and proceed to download, print, or share the completed form as necessary.

Ready to submit your application? Complete your MedCost Recredentialing Form online today!