Get Buckeye Health Plan Behavioral Health Facility/agency Credentialing Application
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How to fill out the Buckeye Health Plan Behavioral Health Facility/Agency Credentialing Application online
Completing the Buckeye Health Plan Behavioral Health Facility/Agency Credentialing Application online is an essential step for facilities seeking to become credentialed. This guide will walk you through each section of the application to ensure accurate and thorough submissions.
Follow the steps to efficiently complete your application.
- Click ‘Get Form’ button to access the credentialing application and open it in your preferred editor.
- Begin with the initial information section. Provide the legal name of the facility, any applicable parent company health system name, and the facility's Doing Business As (D/B/A) name, if relevant. Select the appropriate facility type from the provided options.
- Complete the accreditation information by indicating whether the facility is accredited and providing the name of the accrediting agency, along with the issue and expiration dates of the accreditation.
- Fill out the licensure and certification information, including the issuing entities, types of licenses, license numbers, and expiration dates. Indicate whether there has been a state site visit and attach relevant documents if required.
- Provide detailed information for each facility location. Include the address, phone number, and hours of operation, as well as the languages spoken and whether the location is wheelchair accessible.
- In the administrative information section, provide the administrative and billing addresses, including contact information and provider numbers for Medicaid and Medicare.
- Complete the insurance coverage section by attaching the relevant declaration pages and providing information about current carriers, coverage limits, and policy dates.
- Answer the sanctions and disclosure questions honestly. If any questions are answered with 'yes,' provide additional explanations on a separate sheet.
- Review the Facility Responsibility Form carefully. Sign and date the form at the bottom to certify that the information provided is accurate.
- After completing all sections, save your changes. You may then download the application, print it for your records, or share it via email to the provided address.
Begin filling out your application online today to ensure timely processing and credentialing.
Sunflower State Health Plan is also owned by Centene Corporation. This connection ensures that members receive quality healthcare services similar to those offered by Buckeye Health Plan. If you are a healthcare provider looking to engage with Sunflower or Buckeye, the Buckeye Health Plan Behavioral Health Facility/Agency Credentialing Application is an essential tool for establishing your credentials.