Credentialing criteria by provider type

Requirements by provider type

Individual providers:

• Physician
• Nurse Practitioner
• Physician Assistant
• Chiropractor
• Optometrist
• Certified Nurse Midwife
• Psychologist: PhD, PsyD, EdD
• Limited Licensed Psychologist (LLP)
• Certified Social Worker (MSW, CSW, MALLP)
• Licensed Professional Counselor (LPC)
• Neuropsychologist
• Behavior Analyst
• Acupuncturist (LAc)
• Licensed Marriage and Family Therapist (LMFT)

Organizational providers:

• Acute Rehab Facilities, Home Health Care, Home Infusion, Hospital, Long Term Acute Care and Skilled Nursing Facilities (SNF)
• Behavioral Health Facilities
(Should be submitted via the New Organizational Provider Enrollment only if they're accredited or able to provide proof of a successful CMS survey. If they're not accredited and don't provide CMS survey documentation, please submit all individual practitioners via a New Individual Provider Enrollment.)


• Freestanding Ambulatory Surgery Facility (ASF)
  
• Other health care organizational providers
  • Community-based health centers
  • ESRD providers
  • Federally qualified health centers
  • Hospices
  • Laboratories
  • Rehab facilities (PT, OT, ST)
  • Retail health clinics
  • Rural health clinics
  • School-based health clinics
  • Tribal health clinics
  • Urgent care facilities
• Sleep Disorder Clinics