Credentialing Forms

Employer Resources: Description of Employment Forms | Credentialing Forms | Compliance Forms

 

CAQH Credentialing:  Enrollment data base utilized by multiple payers to credential medical providers. Must be reviewed and updated annually. Link to CAQH website

CMS – 855I Form: Medicare enrollment form for new providers.  Must be completed to receive payment from CMS. Link to CMS.gov

CMS – 855R Form: Medicare re-assignment of benefits form.  Must be completed for the organization to bill CMS on behalf of the individual provider. Link to CMS.gov

Colorado Medicaid Enrollment:  Must be completed to receive payment for services from Medicaid. Link to HCPF website

Colorado Application – CAQH application with all documents or Colorado Healthcare Professionals Credentials Application general form

National Plan and Provider Enumeration System (NPPES) - Individuals or organizations apply for NPIs through the CMS National Plan and Provider Enumeration System website. Link to NPPES website

NEPPS NPI Registry - The NPI Registry Public Search is a free directory of all active National Provider Identifier (NPI) records. Link to NPI Registry Search Tool

Please Note:  The Colorado Department of Regulatory Agencies (DORA) website contains all necessary application forms for physician and physician assistant Colorado Medical License and DEA numbers. Link to DORA website

 

 
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