Step 1: CAQH - Must be Complete before Starting

Step 2: Bridge Credentialing Packet

Credentialing Checklist

• [ ] State licenses; please note our team will review discipline on licenses
• [ ] Correct NPPES Taxonomy matching provider’s training
• [ ] DEA / CDS [If necessary based on clinical practice]
• [ ] Board Certification Confirmation
• [ ] Liability Insurance coverage (COI showing coverage with partner or self-insured policy with limits of $1,000,000 / occurrence & $3,000,000 / aggregate)
  • ⚠️ COI coverage must indicate the individual Provider’s name
• [ ] Medical Diploma or Transcript to Verify Education
• [ ] Resume (CV), Certificates
  • Training confirmation of residency, internship and/or fellowships
  • Work history verification for past 10 years
• [ ] Bridge Forms or “CAQH Forms”: (Completion via DocuSign or wet signature) Docusign Link is Provider in the Body of Welcome Email
  • CAQH Attestation, Authorization & Release form
  • Amendment to Standard Attestation, Authorization & Release form
  • CAQH & PECOS - Limited Power of Attorney form
• [ ] Drivers License (Front Only)