Under 18 V.S.A. § 9408a, enacted during the 2006 Session of the Vermont General Assembly, the Department was required to prescribe a uniform provider credentialing application form for use by all insurers and hospitals in Vermont when credentialing health care providers, effective January 1, 2007. Department Bulletin #122 prescribes the use of the CAQH’s provider credentialing application form for primary source credentialing and recredentialing, outlines how it is to be used, and describes enforcement authority and the effective date. The bulletin and additional supporting documents can also be found using the following links on the Department’s website:
• Printable CAQH credentialing application form (and supplemental form) and online application system access: www.caqh.org/credapp/
• Link to CAQH’s website: http://www.caqh.org/
If you do not have Internet access, you can call the CAQH Help Desk at 888-599-1771 and request an application be sent by mail.
Please note that each insurer and/or hospital may require supplemental credentialing requirements in addition to those outlined on the CAQH application form.
For more information, contact:
Dawn S. Bennett, Health Care Administrator
1-802-828-2923 or firstname.lastname@example.org