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Uniform Credentialing/Recredentialing Provider Application

The Health Insurers and Credentialing Intermediaries Uniform Credentialing Form Act of 2002 authorizes the Commissioner of Insurance, Securities and Banking to promulgate rules and regulations to implement this act. The final regulations became effective on August 11, 2006. As of December 8, 2006, all providers will be required to use the Uniform Credentialing/Recredentialing Provider Application as the sole application to become credentialed or recredentialed in the District of Columbia for a health insurer's provider panel. Providers may obtain a copy of the application by selecting the link below and downloading the document (or they may submit the application online); call Philip Barlow, Associate Commissioner for Insurance at (202) 442-7823 for a hard copy of the application; or requesting the application from the health insurer or its credentialing intermediary that requires a provider to be credentialed or recredentialed.

Once you have obtained the Uniform Credentialing/Recredentialing Provider Application, read the instructions and complete the form. Send the completed form to the appropriate vendor of your choice to process the application.

The DC Department of Insurance, Securities and Banking does not process the Uniform Credentialing/Recredentialing Provider Application.

If you have any questions, please call Philip Barlow at (202) 442-7823.