Get Ga Pshp Facility And Ancillary Credentialing Application 2017-2025
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How to fill out the GA PSHP Facility and Ancillary Credentialing Application online
Filling out the GA PSHP Facility and Ancillary Credentialing Application online can seem daunting, but this guide will provide you with step-by-step instructions to simplify the process. By following these guidelines, you will be able to complete the application accurately and ensure that all necessary documentation is included.
Follow the steps to successfully complete your application online.
- Click the ‘Get Form’ button to access the application and open it in your chosen editor.
- Begin by carefully entering your legal name and any applicable parent company health system name in the designated fields.
- Select the appropriate facility type from the available options for a clear description of your operation.
- Identify the levels of care offered by your facility. Check the boxes that apply accurately to your services.
- Complete the facility location section with accurate addresses and contact information for all sites of operation. Include the Federal Tax ID and necessary NPI numbers.
- Provide detailed contact information for relevant personnel, including the managed care contact, credentialing contact, billing contact, and clinical director.
- Fill out the accreditation information accurately, providing details about your accrediting agency and attaching necessary documentation.
- Indicate your insurance coverage details and attach the required declaration pages as well.
- Complete the accessibility information by indicating the languages spoken at your facility and confirming wheelchair accessibility.
- Answer questions related to any sanctions truthfully, attaching additional explanations if necessary on a separate sheet.
- Read and understand the facility responsibility form, then provide your signature, title, name, and date at the end to confirm accuracy.
- Once all sections are completed, save your changes, and decide whether to download, print, or share the form as needed.
Take the first step towards successful credentialing by completing the GA PSHP Facility and Ancillary Credentialing Application online today.
CMO credentialing in Georgia refers to the process of verifying the credentials of providers affiliated with a Care Management Organization (CMO). This process is essential for ensuring that providers meet necessary qualifications to serve Medicaid beneficiaries effectively. With the GA PSHP Facility and Ancillary Credentialing Application, healthcare facilities can efficiently handle CMO credentialing and maintain high-quality service standards.
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