NOTICE TO ALL PHYSICIAN AND APC APPLICANTS
Once an applicant has been hired and has signed an Employment Agreement, a request for Credentialing information will be sent to the applicant. Upon receipt of this information:
• Optum will provide the applicant a receipt in written or electronic form within seven days.
• Optum will promptly determine whether the application is complete. If it is determined that the application is incomplete, Optum will notify the applicant in writing or by electronic means that the application is incomplete within 10 calendar days after the date the application was received. This notice must describe the items that are required to complete the application.
• If a completed application is received but Optum fails to provide the applicant a receipt in written or electronic form within seven calendar days after receiving the application, the applicant is considered to be a participating physician, effective no later than 53 calendar days following the receipt of the application.
• Please see List A which identifies the documents and information we will need from you to begin your Credentialing with our Organization.
• Please see our Policies and Procedures Document for the full Credentialing Process which outlines all expectations of both the Applicant and Optum,
• Should you need to contact our Credentialing Department you may call 719-538-2900. In addition, you may send an email to email@example.com with any questions or concerns.
The following information may be requested from the On-boarding Clinician once you are hired:
___Current Colorado License
___ Current Colorado DEA (DEA must have Colorado Address before your file is complete for Committee)
___ CAQH completed & attested per above highlighted information
___ User name & password to CAQH, once completed
___ Signature pages for your Colorado Application (complete the questionnaires & sign and date –This will be emailed to you)
___ Signature pages for Medicare enrollment - 855 I & R forms (These will be sent to you via email.
___ Signature page for Tricare enrollment (sign and date page 8 - PDF attached)
___ Professional Liability Insurance certificate of coverage from malpractice insurance carrier from last employer.
___ Medicaid and Medicare Number (if you have this already)
___ Certificate of Medical School (copy of all certificates)
___ Certificate of Board certifications (copy of all certificates)
___ Copy of all Diplomas for Graduate accredited program in specialty practice(s)
___ Curriculum Vitae
___ CME’s (copy of certificates)
___ Copy of BLS/ACLS/PALS/NRP etc.
___ Copy of DD-214 (military discharge) - if applicable
___ Copy of Driver’s License
___ Copy of Passport, if born out of US borders
___ City & State you were born in
___ DOB and SS#