Get Kaiser Permanente Provider Credentialing Application 2019-2025

Filling out the Kaiser Permanente Provider Credentialing Application online is an essential step for organizational providers seeking to join the Kaiser Permanente network. This guide provides clear, step-by-step instructions to help you accurately complete the application.

Follow the steps to successfully complete your application.

1. Click the ‘Get Form’ button to access the credentialing application form. Ensure that you open the form in an appropriate software environment to fill it out electronically.
2. Begin by entering the organizational provider/facility information, including the facility name and address. Ensure that the information is current and correctly formatted.
3. Select applicable organization types from the list provided. This may include options such as acute care hospital, behavioral health care facility, or skilled nursing facility.
4. Input demographic details including the contact name, title, phone number, and email. Provide accurate information to ensure effective communication.
5. Complete the licensure section by specifying the license type, number, and expiration date. Indicate whether any actions have been taken against your license.
6. Respond to the Medicare certification questions. Indicate whether your facility participates in Medicare, is Medicare certified, and if your certification is in good standing.
7. Fill out the accreditation section. Specify if you hold any accreditation, including details like the last survey date and accrediting agency information.
8. Provide insurance and claims information, detailing your professional and general liability insurance coverage levels, policy numbers, and coverage dates.
9. Review all entered information for accuracy and completeness. It is essential to ensure that every required section is fully filled out.
10. Once completed, save changes to the application. You can then download, print, or share the form as needed based on your submission preferences.

Complete your applications online to ensure a smooth credentialing process.