Below you will find the required information and materials for the credentialing process.
- Complete MD-APP credentialing application in its entirety.
- Complete all fields on the application or mark them N/A.
- Include identification numbers, such as Social Security number, National Provider Identifier (NPI), Drug Enforcement Agency number, unique provider ID and professional license numbers.
- Answer all questions and provide explanations if needed.
- Electronically sign and date forms and application upon submission
Attach copies to your application:
- Curriculum vitae, including work history in a month/year format
- Professional license
- DEA certificate (if applicable)
- Controlled Dangerous Substances (CDS) certificate (if applicable)
- Copy of malpractice insurance face sheet
- Summary of pending or settled malpractice cases
- MDStaffApp: Email
- Amanda Zoller, recredentialing last name A-I: 303-673-715
- Robin Valdez, recredentialing last name J-Z: 303-673-7821
- Heather Wright, initial credentialing SDOG: 303-673-8268
- Cheri Lipps-Brindle, initial credentialing SWOG, KSOG, Hospitalist: 303-673-7515
- Shelly Ackerly, initial credentialing SSOG, MNDOG: 303-673-7131
- Within seven calendar days after a carrier receives an application, the carrier shall provide the applicant a receipt in written or electronic form.
- Upon receiving an application, a carrier shall promptly determine whether the application is complete. If the carrier determines that the application is incomplete, the carrier shall notify the applicant in writing or by electronic means that the application is incomplete within ten calendar days after the date the carrier received the application. The notice must describe the items that are required to complete the application.
- If a carrier receives a completed application but fails to provide the applicant a receipt in written or electronic form within seven calendar days after receiving the application, as required by (2) of this section, the carrier shall consider the applicant a participating physician, effective no later than fifty-three calendar days following the carrier's receipt of the application.
