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Credentialing

  • Credentialing refers to the process of physician's completing a paper application or online form that provides his/her academic, residency, fellowship, employment, licensing, certification and liability-related data for input into a centralized file. Often a physician's credentialing file is housed at his/her practice and affiliated hospital. Most hospitals and insurers use the  Universal Provider Datasource (UPD), maintained by the  Council for Affordable and Quality Healthcare (CAQH), as a repository for data about physicians and many payers require that physicians have an active and regularly revalidated UPD file in order to submit information for contracting purposes. A credentialing data file may be accessed and reviewed by a health system, hospital, facility or insurer prior to offering the physician privileges or enrolling him/her within a health plan.

    Illinois' Health Care Credentials and Data Collection Act stipulates that common forms be utilized in collecting physician data for credentialing purposes. This lessens the instances of duplicative completion of paperwork associated applying for contracting with health plans and staff privileges at hospitals and facilities. The State's  Health Care Professional Credentialing and Business Data Gathering Form  can be completed by Illinois physicians and faxed to CAQH for manual entry into the physician's UPD account.

    Resources


  • This won't hurt a bit ... but you do have to do it once!

    Since January 1, 2002, uniform credentialing forms have been available to Illinois physicians, for use by all hospitals and health plans.

    While completion of these forms is mandatory, the data can be entered just once. This will greatly reduce paperwork headaches for you and your staff, because the new forms must be accepted by all hospitals, health plans, and other organizations with which you may be affiliated.

    These forms are formatted for use with Microsoft® Word® 97/2000 for Windows® and Microsoft Word 98/2001 for Macintosh.® Use of previous versions of these programs will alter and invalidate the forms.

    Illinois health care entities cannot accept altered credentialing forms.

    IDPH Health Care Credentialing forms  

    These forms are provided as a members-only benefit. To download you will be asked to log-on. To learn how to do this or to request your username and password please go to our member assistance area.

    To download the file follow the instructions below:

    1. Right click the appropriate icon
    2. Select "Save target as . . ."
    3. When prompted, save the file with a name and in a place that you can remember.

    Before starting, be sure to save the credentialing form to your computer's hard drive. As you fill in the form, save your work frequently.

    Initial - Word | PDF

    Recredentialing - Word | PDF

    Update - Word | PDF

    Important information before printing:

    Before you print, update the credentialing form's "fields." This will ensure that your name and personal data are automatically updated throughout the form.

    PC:

    1. Go to the "Tools" pulldown menu and select "Options."
    2. Click on the "Print" tab in the "Options" menu.
    3. Click on the "Update fields" box.
    4. Click the "OK" button.
    5. Save your work on your PC's hard drive. You are now ready to print.

    Macintosh:

    1. Go to the "Edit" pulldown menu and select "Preferences."
    2. Click on the "Print" tab in the "Preferences" menu.
    3. Click on the "Update fields" box.
    4. Click the "OK" button.
    5. Save your work on your Mac's hard drive. You are now ready to print.

    Questions? Call Health Policy Research at (800) 782-4767 ext. 1470 or email: credentialing@isms.org



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