Get Ca Optum Facility Cred App 2014

Completing the CA Optum Facility Credentialing Application is an essential step for facilities seeking to participate in the Optum network. This guide provides a detailed overview of the application process, ensuring that users can navigate each section confidently.

Follow the steps to successfully complete the CA Optum Facility Cred App.

1. Click ‘Get Form’ button to initiate the process and access the application for completion.
2. Review the instructions thoroughly to understand what is required. Ensure all fields in pages 2-6 are completed without leaving any information blank.
3. On page 2, provide organizational facility identifying information such as the legal name, administrative address, and contact details. Ensure these details are accurate to facilitate communication.
4. Indicate the levels of care your facility desires to contract. Select from options including substance abuse, psychiatric, and other levels of care relevant to your services.
5. Identify practice locations by listing all the facility addresses and their corresponding contact information. If necessary, include additional pages for more locations.
6. Fill in the organizational provider contact information for each role stated in the application. Make sure to include at least one primary contact per specified role.
7. Complete the accreditation and licensure sections by providing relevant dates, types of licenses or certifications held, and expiration information.
8. Detail your facility's Medicare, Medicaid, NPI, and KePRO numbers, ensuring you validate them as required.
9. Provide information regarding general and professional liability insurance, including limits and policy details. Ensure to attach any required documentation.
10. Review all legal statuses related to disciplinary actions or investigations involving the organizational provider and provide explanations if applicable.
11. Complete the location accessibility information and verify that all conditions apply to your facility.
12. Sign and date the application, confirming the accuracy of the submitted information. Include your printed name and title.
13. Prepare all necessary documents as per the preparation checklist. Attach required documentation before submission.
14. Once everything is filled out correctly, you can save changes, download, print, or share the completed form as needed.

Begin your credentialing process now by completing the CA Optum Facility Cred App online.