Get Trillium Health Resources Credentialing Application To Participate As A Health Care Provider 2021-2025

Navigating the credentialing application process can be complex, but this guide aims to simplify the experience for prospective health care providers. By following these detailed steps, you will be able to successfully fill out the Trillium Health Resources Credentialing Application and ensure your submission meets all required standards.

Follow the steps to complete your credentialing application online.

1. Press the ‘Get Form’ button to access the application form and open it in your preferred editing interface.
2. Begin by filling out the corporate information section. This includes the legal name of the organization, federal tax ID, NPI, and organization address. Ensure all fields are completed accurately.
3. Provide details about the insurance requirements and attestation. Include certificates of insurance and verify that the organization meets all necessary coverage requirements.
4. Complete the ownership information section. List all shareholders or partners with 5% or more ownership, and provide relevant personal information such as names, addresses, and titles.
5. In the site-specific information section, detail each physical location where services will be provided. Include the site name, address, services rendered, and contact information.
6. Address all questions regarding the organization’s history, including any previous legal issues or insurance claims. Attach explanations where necessary.
7. Review the entire application to ensure all sections are filled out completely. Use 'N/A' in any fields that do not apply to your organization.
8. Finalize your application by signing the attestation statement. This confirms that all information provided is accurate and complete.
9. Once all steps are complete, save your application, then download or print a copy for your records. Share the completed application by emailing it to Credentialing@TrilliumNC.org.

Complete your application online today to ensure timely participation as a health care provider with Trillium Health Resources.