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Registration: When you register an account, the account will be unique to each provider. Please ensure the account name you register with is the provider’s name. Once you are registered you will be able to enter a credentialing contact name within the credentialing application. If you are submitting applications for multiple providers, you will create unique accounts for each.
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Email addresses: an email address is required to register with Application Central. When you create your account as a new provider you can provide two email addresses:
a. Personal Email (Required): Used to send a personalized link to access your credentialing application and status updates throughout the credentialing process. When Recredentialing is due (typically every 36 months), this email is used to send the link to complete your application.
b. Credentialing Email (Not Required): This email will not receive the link to log-into your personalized credentialing application, but will receive all status updates and requests for additional information where applicable.
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Practice locations: You are not required to enter every practice location into the online credentialing application. You are required to enter a minimum of the following locations:
a. Primary Treatment Location
b. Credentialing Correspondence Location
c. Billing/1099 Location
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If any of these locations are the same, simply check the applicable boxes:
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If any of these locations are not the same, click “copy page” on the top of the location page to add additional location pages. Be sure to check the location type for each address you enter.
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If you have additional treatment locations you may enter them by continuing to click “copy page.” However you may also fax us your addition locations as follows:
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Open the “Additional Location Required Information” document and print the fax-back cover page. You can find this document in your document process (the home screen once logged-in).
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Fax us your list of locations with the fax-back cover page.
Required information for each location – a template is provided for your convenience –
click here.
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Practice Name
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Individual Medicaid ID
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Address Line 1
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Address Line 2
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City, State, Zip
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Tax ID
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Phone Number
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Group NPI
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Accepting New Patients: Yes or No.
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Office Type: Ambulatory Surgical Center, Article 28 (NY), Clinic, FQHC, Hospital.
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Office hours, if different than the Primary Service Location
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Language(s) spoken at office, if different than the Primary Service Location.
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Do you accept Special Needs Patients? Yes or No.
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If yes, and the following is the same as the Primary Service Office you do not need to complete the following. However, if any of the following is different by service office, please provide a “yes” or “no” response to each item for each service office:
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Is your office handicap accessible?
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Is your entry way handicapped/wheelchair accessible?
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Is your waiting room handicapped/wheelchair accessible?
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Are your bathrooms handicapped-wheelchair accessible?
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Are your treatment rooms handicapped/wheelchair accessible?
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Does your office provide access to a Skilled Medical Interpreter?
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Is your office accessible by public transportation?
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Are translation services available?
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Do you provide sedation services for members with complex medical or behavioral conditions?'
Before you register here are some helpful video tutorials!
· How to Register your Account 4:02
· How App Central works 12:19
· Where do the checks go? 7:13
· What you need to know before you get started 1:34
Create an account and register NOW!