| May 2024 – The Iowa Credentialing Coalition (ICC) releases new provider application forms Beginning July 1, 2024, only the current version of the provider “credentialing” and “re-credentialing” forms will be accepted by receiving entities. There were only 2 changes that were requested by NCQA and the Medical Boards. Quality Focus Question #15 was modified and Question #16 was added, which required us to change just the question numbers on the rest of the Quality Focus Questions. The rest of the application remained unchanged. These may be used immediately. Older applications will not be accepted after June 30, 2024. The Iowa Credentialing Coalition provides the applications in either “hard copy” or “template” versions. The “hard copy” version allows clinicians to print the application to be completed by hand. The “template” version allows clinicians to open the document in Microsoft Word and fill in the information from a computer. The “template” version also allows facilities to create a master copy for a clinic, keeping the static information as a master and then just changing the individual specific information. There is also an “unprotected” version available for large-scale credentialing entities using a mail-merge feature. A request for unprotected documents can be emailed to: IowaCredentialing@gmail.com All hospitals accept the Universal Provider credentialing and re-credentialing applications, unless that hospital system has gone to an on-line portal process. For re-credentialing, many entities provide a semi-completed re-credentialing form to update. Many insurance carriers have moved to CAQH on line data repository, some have moved to their own proprietary on-line systems. Please check with any potential insurance carrier about their requirements. Forms and News Releases – Click below to download the current application(s) of your choice: • Initial Provider Application (ISUPA) – hard copy (Version 1.9) • Initial Provider Application (ISUPA) – template (Version 1.9) • https://pcms.org/wp-content/uploads/2024/07/ISUPRA-Version-1.7-Hardcopy-2024-FINAL.doc • https://pcms.org/wp-content/uploads/2024/07/ISUPRA-Version-1.7-Template-2024-FINAL.doc • Statewide application checklist – 2024 • General Release form Initial Application – 2024* • General Release form Re-cred Application – 2024* *The release forms are already included with all applications, however if you need just the release forms, they are available by themselves. Email Mitch Harris at the Iowa Credentialing Coalition with any questions: IowaCredentialing@gmail.com |
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