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  • Or Moda Health Oregon Practitioner Credentialing Application 2012

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Professional training? Yes Name(s) and Year(s) Used: Home Street Address: Home Telephone Number Email Address: City: State: ZIP: Country: Birth Date: Month / Day / Year Birth Place: Citizenship: Social Security Number: Immigrant Visa Number (if applicable): Gender: Male Visa Expiration Date Status: Educational Commission for Foreign Medical Graduates (ECFMG) Number (if applicable): III. SPECIALTY INFORMATION No Mobile/Alternate Number Female Type: Month / Year Issued:.

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Three primary mechanisms for credential- ing include licensure, certification, and accreditation.

The provider submits an application to the insurance network or government payer they wish to enroll with. This application often requires detailed information about the provider's qualifications, licensing, certifications, practice location, Tax Identification Number (TIN), and other relevant details.

When you submit your credentialing request to the payer, the payer will often start the process of verifying the legitimacy of a provider's credentials through various databases including CAQH. Once these credentials are verified, the provider is then added to the roster associated with your contract.

The provider simply submits a request to a payer or health insurance network to enroll in that network as a provider. From here, several steps take place to complete the full process: The provider completes the credentialing process. The provider submits the necessary documents to verify credentials.

Definition/Introduction Credentialing is a formal process that utilizes an established series of guidelines to ensure that patients receive the highest level of care from healthcare professionals who have undergone the most stringent scrutiny regarding their ability to practice medicine.

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© Copyright 1997-2025
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232