Credentialing: Submission Checklists

Did you include a copy of your current accreditation (Note: if not accredited, please include a copy of your most recent Centers for Medicare & Medicaid Services (CMS) – Medicare site survey.)

Accreditation organizations include:

• Accreditation Association for Ambulatory Health Care
• American Academy of Sleep Medicine
• American Association for Accreditation of Ambulatory Surgery Facilities
• American Osteopathic Association
• Commission for the Accreditation of Birth Centers
• Commission on Accreditation of Rehabilitation Facilities
• Community Health Accreditation Partner
• Council on Accreditation
• Det Norske Veritas
• RadSite for the Accreditation of Diagnostic Imaging
• The Joint Commission Accreditation
• Other accrediting body

Did you include any general and professional claims settlement history details?

• Initial applicant: Provide any settlement or adjudication that resulted in payment of $25,000.00 or greater in the past 5 years. 
• Recredentialing: Provide any settlement or adjudication that resulted in payment of $25,000.00 or greater in the past 3 years.

Did you include evidence of Medicare certification?

• Include a copy of the letter assigning the Medicare number if possible.
• If there are multiple locations, each location must have its own number or written permission to use an existing Medicare number.

Arizona, Idaho, Nebraska, and Washington Only: Did you include a copy of your current CMS total performance score and performance adjustment report, if a home health provider?  

Did you fax the report to your Health Net Federal Services, LLC (HNFS) claims administrator at 1-844-730-1373?

Address:

• This must match the U.S. Postal Service (USPS). Check addresses through the Look Up a ZIP Code tool at www.usps.com.
• You do not need to include suite, floor, building, tower, or plaza information.