Blank Idaho Practitioner Application PDF Form

Filling out the Idaho Practitioner Application form can be a detailed process, and many applicants make common mistakes that can delay their credentialing. One frequent error is failing to complete all sections of the application. Every section must either be filled out with the appropriate information or marked as “Does Not Apply.” Simply referencing a resume or curriculum vitae is not sufficient. This omission can lead to the application being deemed incomplete, which will cause delays in the processing time.

Another mistake often made is neglecting to include all necessary licenses and certifications. Applicants should list both current and expired state professional licenses, including those specific to Idaho. Missing out on this information can raise red flags during the review process. Additionally, if certifications are required, such as those for nurse practitioners or allied health practitioners, copies must be attached. Without these, the application may be rejected outright.

Inaccurate or outdated information is another pitfall. The application requires that all information be current and accurate. For instance, the DEA registration number and professional liability insurance details must reflect the most recent status. If the information provided is more than 180 days old at the time of submission, it will not be accepted. Therefore, it is crucial to double-check all dates and numbers before submitting the application.

Finally, many applicants overlook the importance of signatures and dates. Certain pages, such as the Idaho Practitioner Attestation Questions Form, must be signed and dated. Any alterations made to the application must also be initialed and dated. Failing to do so can result in the application being considered invalid. Each of these steps is critical for ensuring that the application moves smoothly through the credentialing process.

1. What is the purpose of the Idaho Practitioner Application form?

   The Idaho Practitioner Application form is designed for healthcare professionals seeking credentialing with Blue Cross of Idaho. It collects necessary information about the applicant's professional background, education, work history, and licenses to ensure compliance with state and organizational requirements.

2. What documents are required to submit with the application?

   Applicants must include several documents with their application, such as:

   • State professional licenses (current and expired)
   • DEA registration information
   • Proof of professional liability insurance
   • Education details, including transcripts
   • Copies of certifications (if applicable)
   • Completed Idaho Practitioner Attestation Questions Form
   • Release of Authorization Form

3. How should I fill out the application?

   The application should be completed in its entirety using black or blue ink. It is important to keep a signed and dated copy for your records. If a section does not apply, simply check the box provided at the top of that section. If you need to make changes, strike out the incorrect information, write in the correction, and initial and date it.

4. What happens if my application is incomplete?

   Incomplete applications cannot be processed. If any required information or documents are missing, this will delay your ability to contract with Blue Cross of Idaho. Therefore, ensure that all sections are filled out accurately and completely before submission.

5. How long does the credentialing process take?

   On average, the credentialing process takes between 60 to 90 days. It is advisable to submit your application well in advance of when you need it to be processed to allow for any potential delays.

6. What should I do if I have questions about the application?

   If you have questions regarding the application or the credentialing process, you can contact the credentialing staff at Blue Cross of Idaho. They can be reached by phone at 208-286-3447 or 208-472-5112.

7. Can I check the status of my application?

   Yes, applicants have the right to inquire about the status of their application. You can do this by contacting the credentialing staff via telephone or in writing. They are required to respond within 15 calendar days regarding your application's status.

8. What if I need to provide additional information after submission?

   If there is a need to provide additional information after your application has been submitted, you will be contacted by credentialing staff. You will have the opportunity to correct any discrepancies or provide further documentation within 30 calendar days.

9. Is there a time limit on the information I provide?

   Yes, the information submitted in your application cannot be more than 180 days old at the time of review by Blue Cross of Idaho. Be sure to keep your information current to avoid any issues during the credentialing process.

When filling out the Idaho Practitioner Application form, it is essential to follow certain guidelines to ensure a smooth process. Below is a list of things you should and shouldn't do.

• Do complete all sections of the application, marking “Does Not Apply” where necessary.
• Do provide a copy of your current professional liability insurance face sheet.
• Do ensure that all information is accurate, current, and legible.
• Do sign and date the required pages of the application.
• Don't use abbreviations in any part of the application.
• Don't submit the application without attaching all required documents.
• Don't alter the format or wording of the application, as this may invalidate it.
• Don't submit outdated information; ensure your application is no more than 180 days old.

When applying for practitioner credentials in Idaho, several forms and documents accompany the Idaho Practitioner Application. Each of these documents plays a crucial role in ensuring that the application is complete and meets the necessary requirements for review. Below is a list of commonly required documents that applicants should be prepared to submit along with their application.

• Completed Application: This is the primary document that must be filled out entirely. It requires applicants to provide detailed information about their professional history, education, and qualifications. Incomplete applications can lead to delays or rejection.
• Mobile Home Bill of Sale Form: To ensure proper ownership transfer, utilize the detailed Mobile Home Bill of Sale form requirements for a legally binding sale.
• Licenses: Applicants must list all current and expired professional licenses, including those specific to Idaho. This information helps verify the practitioner's legal ability to practice.
• DEA Registration: If applicable, a copy of the Drug Enforcement Administration (DEA) registration is required. This document confirms the practitioner's authorization to prescribe controlled substances.
• Education Records: Documentation of educational history is necessary. This includes the names of institutions attended, degrees obtained, and the dates of attendance.
• Certifications: Applicants should provide information on any board certifications or other relevant certifications. This is particularly important for nurse practitioners and allied health practitioners, who must also submit copies of their professional certifications.
• Hospital Affiliations: A list of current and pending hospital affiliations must be included. This information is vital for understanding where the practitioner may provide services.
• Work History: A comprehensive work history for the past five years is required. This includes explanations for any gaps in employment, ensuring a clear picture of the practitioner's professional journey.
• Liability Insurance: A copy of the current professional liability insurance face sheet must be submitted, demonstrating that the practitioner meets the minimum coverage requirements.

Completing these documents accurately and thoroughly is essential for a smooth credentialing process. It is advisable for applicants to double-check all information and ensure that it is current and complete before submission. This diligence can significantly reduce the time it takes to process the application and facilitate a successful outcome.