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Get Ca Optum Facility Cred App 2015
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How to fill out the CA Optum Facility Cred App online
Completing the CA Optum Facility Credentialing Application online can streamline your application process and ensure it meets all necessary requirements. This guide provides a comprehensive overview to assist users in accurately filling out each section of the form.
Follow the steps to successfully complete your application.
- Press the ‘Get Form’ button to access the form and open it for editing.
- Thoroughly fill out pages 2 to 6, ensuring that all information is complete. The individual authorized to attest to the information must sign on page 6, including the date and their printed name.
- If you are a new facility applicant, complete pages 7 to 10 as required. If a specific component does not apply to you, indicate it as N/A to avoid leaving fields blank.
- Provide all necessary organizational facility identifying information. This includes the legal name, parent company, administrative address, and contact information.
- Identify the levels of care your facility wishes to contract, selecting all that apply from the listed options.
- Enter practice locations corresponding to the selected levels of care, including admission phone numbers and secure fax information.
- Complete the organizational provider contact information section with necessary details for various contacts including administrators and clinical directors.
- List all relevant accreditation information, including issue and expiration dates, and indicate if any are not applicable.
- Provide details of licensing and certifications, including the entity issuing each license, type, number, and expiration date.
- Before submitting, ensure all documents requested in the preparation checklist are attached, including any necessary explanations for any prior disciplinary actions or claims.
- Finally, save your changes, and you may choose to download, print, or share the completed form as needed.
Complete your CA Optum Facility Credentialing Application online to ensure a smooth and efficient credentialing process.
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For billing inquiries, you can reach Optum by calling the provider support line at 1-855-427-4682. This number allows you to address issues specifically related to the CA Optum Facility Cred App and billing questions. It is advisable to have your account details handy when you call for a smoother experience.
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