Get Credentialing Application Provider And Office Information - Humana Webcvo

Filling out the Credentialing Application for Provider and Office Information through Humana Webcvo is an essential step for dental providers looking to join Humana’s network. This guide will walk you through the process step-by-step, ensuring that you complete the application accurately and efficiently.

Follow the steps to complete your application with ease.

1. Click the ‘Get Form’ button to obtain the Credentialing Application and open it for filling out.
2. Begin by entering your personal information in the designated fields. This includes your last name, first name, dental degree (DDS or DMD), date of birth, and Federal Tax ID number, along with the billing name, middle initial (MI), and gender.
3. Provide your National Provider Identifier (NPI) number and Social Security number, along with your office contact details such as the street address, suite number, city, state, ZIP code, phone number, fax number, website, and email address.
4. Fill in your office hours for each day of the week, specifying the minimum and maximum ages of patients you accept, and the languages spoken in your practice.
5. Complete the education section by providing the name of the dental school you graduated from, the state where it is located, and year of graduation. Indicate your board certification status, if applicable, and name of the certifying board.
6. Outline your dental specialty and the institution where you completed any residency or postgraduate specialty training, along with the state and year of graduation.
7. Enter your professional licensure information, including your state license number and any Medicaid number, if applicable. Also, provide your Drug Enforcement Agency (DEA) registration number, attaching a brief explanation if you do not have one.
8. Chronologically list your five-year work history. Include details about your place of employment for each position held, specifying start and end dates. If there are gaps in employment lasting six months or longer, provide explanations.
9. Ensure you have a completed W-9 form ready to submit along with your application. Review all information to make sure it is accurate and complete.
10. After completing the form, save your changes, download the completed application, and print a copy for your records. You can then share or submit your application via fax or email to the provided addresses.

Complete your Credentialing Application online today to ensure you are ready to join the Humana network.