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Supero Healthcare Solutions Provider Enrollment and Credentialing Blog

Provider Enrollment - Tips for Success - Be Prepared! (Step 2)

Posted by Brian Agnew on Tue, May 31, 2011 @ 21:05 PM

Provider Enrollment, Be Prepared, Stack of Paper

In the second step of the series, after choosing which contracts to pursue from payors like Aetna, BCBS, CIGNA, Humana, UnitedHealthcare, and Medicare.

The second step in this process is to be prepared!  I see so many providers that are ready to start, but can't put their fingers on any required credentialing documentation.



 Click here to learn more about provider enrollment/ credentialing assistance.

Here is a quick checklist that I recommend that you have ready before beginning the provider enrollment process:

  • Full Legal Name of Corporation

  • Practice Demographics (Address, Phone, Fax, Website, Contact Person, E-mail address)

  • Owner Information for All Owners (Need name, SS#, NPI#, Date of Birth, Place of Birth, Medicare #)

  • Federal, State, and/or Local professional licenses, certifications, and or registrations for the company

  • IRS CP575 Form (This is the official document with Tax ID#)

  • W-9 (Physical Address)

  • W-9 (Billing Address)

  • Curriculum Vitae (CV)

  • Date of Birth

  • Place of Birth (City, State, Country)

  • Copy of Drivers License

  • Social Security Number

  • Copy of Professional Degree(s, Certifications, and/or Evidence of Qualifying Coursework(Needed for Medical Directors and all Owners)

  • State Medical License

  • Board Certification(s)

  • General Liability Insurance (Facesheet)

  • Professional Liability Insurance - Malpractice (Facesheet)

  • Malpractice History (Very important!)

  • DEA and/ or Controlled Substance Certificate

  • Copy of ACLS

  • Billing Company Information (If Applicable)

  • Letter from Bank (This is sent to Medicare to verify that a bank account has been setup. Needs to come from a bank representative with account information outlined.) A voided check is also acceptable.

  • Copy(s) of all CLIA Certificates, FDA Mammography Certificates, and Diabetes Education Certificates, (If applicable)

  • Copy(s) of all State Pharmacy licenses, (If applicable)

  • Hospital Privileges (If applicable)

Seems like a long laundry list of items, but I assure you, if you have this ready to go from the start, this will make life easier and you will complete your provider enrollment much quicker.

If you need assistance with the provider enrollment process, click here to contact our office today!


Brian Agnew is President of Supero Healthcare Solutions a leading practice management company focused on provider enrollment and credentialing services for physicians and other healthcare providers.


Topics: Provider Enrollment, Payor Contracting, Payor Credentialing, Physician Credentialing, Medical Credentialing, Provider Credentialing, Insurance Credentialing, Managed Care Contracting and Credentialing