Get Ca Optum Facility Cred App 2017-2026

This guide provides a comprehensive walkthrough for completing the CA Optum Facility Credentialing Application online. It is designed to assist users in navigating each section of the form with clarity and confidence.

Follow the steps to complete your application effectively.

1. Click ‘Get Form’ button to obtain the credentialing application form and open it in the editor.
2. Begin by answering whether your facility is currently part of the Optum network by selecting 'Yes' or 'No' in the designated field.
3. Fill in the organizational facility identifying information, including the legal name of the facility, administrative address, contact details, and tax identification number.
4. Indicate the levels of care your facility seeks to contract by selecting the appropriate options, such as adult, adolescent, or geriatric services, among others.
5. Provide facility location details, including admission phone numbers and bed availability for each level of service you have marked.
6. Complete the accreditation information by listing relevant certifications, including issue and expiration dates where applicable.
7. Respond to the licensure and certification requirements with the appropriate license numbers and expiration dates as required for the selected levels of care.
8. Fill out the general and professional liability sections, attaching any necessary documentation regarding insurance coverage.
9. Declare the legal status of your organization by addressing any disciplinary actions or investigations, along with necessary explanations if applicable.
10. Complete the accessibility information, specifying hours of operation, and whether the facility meets accessibility requirements.
11. Review and sign the certification statement, ensuring that all provided information is complete and accurate.
12. Save your changes. You may now download, print, or share your completed application.

Start completing your CA Optum Facility Credentialing Application online today.