Provider Credentialing

Credentialing is the process of obtaining and reviewing documentation to determine participation status in a health plan. The documentation may include, but is not limited to, the applicant’s education, training, clinical privileges, experience, licensure, accreditation, certifications, professional liability insurance, malpractice history and professional competence. Generally, the timers credentialing and re-credentialing include the review of the information and documentation collected, as well as verification that the information is accurate and complete.

For answers to questions regarding credentialing status or the process described below

Call:	(888) 733-1906
Email:	admin@advancedmso.com
Hours of Operation:	Monday – Friday, 9:00AM – 5:00PM

Credentialing Process

Our IPA accepts the use of Council for Affordable Quality Healthcare (CAQH) Proview^TM, a service that provides a fast and easy way to securely submit credentialing information to multiple plans and networks by entering information just once. Application data can be submitted online at any time. This simplified credentialing process reduces paperwork and saves time. It is provided at no cost.

To become credentials for the first time, you will need a current and complete application.

Please be sure to:

Complete all fields on the form or mark them “N/A”
Include all prior and current practice locations.
Include identification numbers, such as the physician or provider’s Social Security Number, National Provider Identifier (NPI), Drug Enforcement Agency Number, unique provider ID, and professional license numbers.
Answer all questions and provide explanations if needed.
Include the signed and dated attestation form.

Provide digital copies of your:

Curriculum vitae, including work history in a month/year format
Professional license or DEA certificate
Controlled Dangerous Substances (CDS) certificate
Copy of malpractice insurance face sheet
Summary of pending or settled malpractice cases

Credentialing Forms

Click below to download the forms and complete your Credentialing status.

CAQH Attestation Form

Full CPPA Application

Supervising Physician Assistant Agreement

Mid-Level Provider Application

To submit a form, please send an email to admin@advancedmso.com with the following information:

Full name
Email
Application Type
Contact Number
NPI
Tax ID
License Number
Group or practice name

Please make sure to provide all the information to process your form correctly.