|
 credentialing information
To join the CNC network, all providers must complete the credentialing process. This process takes approximately 4 to 6 weeks. CNC strictly adheres to both URAC and NCQA guidelines for credentialing. Our providers are subject to criteria that examine education, certification, licensure, practice history, criminal history, malpractice history, and 24-hour practice coverage. All participating providers are subject to recredentialing every three years.
The credentialing process begins when we receive a completed credentialing application with attachments as requested in your application packet. Please be aware that completion and submission of an application is not a guarantee of acceptance in our network.
Once the credentialing process is complete, you will be notified in writing of the credentialing committee’s decision via U.S. Mail.
Credentialing Instructions
North Carolina, South Carolina and Virginia professional providers are required to complete the North Carolina Department of Insurance’s Uniform Application to Participate as a Health Care Practitioner.
Following these instructions carefully will assist in expediting the credentialing process.
Before submitting your application packet, please make sure that your packet contains:
- The completed Checklist attached to your application
- Signed and dated Attestation statement
- A completed W-9 form
- Hold Harmless Agreement (for NC & SC Providers only)
- Completed application with current date and signature
- Copy of provider’s state license registration clearly showing expiration date
- For NC providers, this is the large 8 1/2” x 11” license renewal showing the expiration date of your license
- For SC providers, this is the small, wallet-size registration showing the expiration date of your license
- For VA providers, this is the 8 1/2" x 4" license renewal showing the expiration date of your license
- Explanation to all “Yes” responses on the “Professional Information” questionnaire
- Copy of the fact sheet from your current professional liability insurance policy indicating:
- Name of provider
- Minimum coverage amount of $1,000,000/$3,000,000
- Effective date and expiration date (Policy coverage dates)
- Policy number
- Complete work history, beginning with date you graduated from Chiropractic College. All gaps of 90 days or more must be explained in writing on a separate sheet. In completing the work history on page 8, you must begin with the date of your Chiropractic College graduation (on page 7). On page 8, list all work since the date you graduated from Chiropractic College through today’s date.
- Two signed & dated Provider Agreements
- Two signed & dated Business Associate Addendums
- Two Completed Provider Evaluation Forms (Letters of Recommendation)
- Completed ChiroTrack® Registration Form
- Signed ChiroTrack® Provider Agreement (EDI Agreement)
The checklist attached to your application must be completed and returned with the application.
Please do not leave any sections blank. Please write N/A if not applicable.
If you have any questions about how to complete your credentialing application, please contact Ms. Sandy Cooke, Director of Credentialing, at (919) 341-8033 or email her at scooke@cncarolinas.com.
Please call CNC to review the application by phone BEFORE mailing to CNC. This will significantly expedite the credentialing process!
Provider Rights:
The following rights are for each provider applying for credentialing and/or recredentialing with CNC:
- To review information submitted to support credentialing application
- To correct erroneous information
- To be informed, upon request, of their credentialing and/or recredentialing application status
- To be notified of these rights
recredentialing
CNC is required to recredential participating professional providers every 3 years. CNC will notify you that it is time to recredential at least 2 months before your current credentials expire. We mail your credentialing application packet to the address on file in our system so it is imperative that you notify us immediately if you have a change in your practice or mailing address.
It is extremely important that you return your application by the stated due date. If your completed recredentialing application, together with the required documents, is not received by the due date stated, your participation in the CNC network will be terminated.
In order to assist you with this process, we have completed parts of the recredentialing application for you.
It is very important that you carefully review each section to assure the accuracy of the information before submitting to CNC. If any of the pre-filled information is incorrect, please provide correct, current information.
If you have any questions about how to complete your recredentialing application, please contact Ms. Sandy Cooke, Director of Credentialing, at (919) 341-8033 or email her at scooke@cncarolinas.com. The checklist attached to your application must be completed and returned with the application.
Prior to submitting your application packet, please make sure that your packet contains:
- Completed application with current date and signature
- Copy of provider’s state license registration clearly showing expiration date.
- For NC providers, this is the large 8 1/2" x 11" license renewal showing the expiration date of your license
- For SC providers, this is the small, wallet-size registration that shows the expiration date of your license
- For VA providers, this is the 8 1/2" x 4" license renewal showing the expiration date of your license
- Copy of the fact sheet from your current professional liability insurance policy indicating:
- Name of provider
- Amount of coverage (minimum coverage requirement is $1,000,000/$3,000,000)
- Effective date and expiration date (Policy coverage dates)
- Policy number
- Explanation to all “Yes” responses on “Professional Information” questionnaire.
You must not leave any sections blank. Write N/A if not applicable.
- Signed and dated Attestation statement
- 2 signed and dated Provider Agreements
- 2 signed and dated Business Associate Addendums
- Hold Harmless Agreement (for NC and SC Providers only)
If you have any questions while completing the recredentialing application, please call us at (919) 341-8033. We will be happy to assist you.
Provider Rights:
The following rights are for each provider applying for credentialing and/or recredentialing with CNC:
- To review information submitted to support credentialing application
- To correct erroneous information
- To be informed, upon request, of their credentialing and/or recredentialing application status
- To be notified of these rights
|
