Provider Credentialing Forms

Only these versions of the provider credentialing and re-credentialing forms are accepted by receiving entities. An unprotected version of the form is available on request for large-scale credentialing using a mail merge feature. Hospitals accept universal provider credentialing and re-credentialing applications unless they use an online portal. For re-credentialing, many entities provide a semi-completed re-credentialing form to update. Many insurance carriers have moved to the Council for Affordable Quality Healthcare’s online data repository or have proprietary online systems. Check with potential insurance carriers about their requirements. Email questions to Mitch Harris at the Iowa Credentialing Coalition.


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