NCQA accreditationCentralized Provider Verification Service
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NCQA certified
CVO		  application management
NCQA certification
sanction monitoring
CredentialsOnLine
17085 Camino San Bernardo
San Diego, CA 92127		 TEL: 800-733-8737
TEL: 858-673-1700
FAX: 858-673-3888 		 
Map/Directions    
     
Credentialing Services: Sales@credentialsonline.com  
Client Support: Clientservices@credentialsonline.com  
Career Opportunities: HR@credentialsonline.com  
Website Inquiries: Webmaster@credentialsonline.com  


Request Form to receive additional information
on CredentialsOnLines credentialing services.
 
First Name: Last Name:

Title: Organization:

Address: City:
State: Zip:
Phone: E-mail:
Your total number of providers:
Types of providers you credential:
(i.e., MD, DO, PhD, MSW, PA)
How many NEW applications do
you process each month?
Which items do you require for new applicants?
         State medical license
         Federal DEA or CDS certificate
         Malpractice coverage
         Malpractice claims history
         License sanctions
         HFCA Medicare/Medicaid sanctions
         Medical education
         Post graduate training
         Board certification
         Professional references
         Primary hospital affiliation
         All hospital affiliations and clinical privilege requests
         Continuing medical education (CME) courses
         Academic/Faculty appointments
Any other items not listed:
Are you seeking NCQA accreditation?

Yes   Not Sure   No
Are you seeking JCAHO accreditation? Yes   Not Sure   No
What is the date of your
next survey?
Will you use an electronic (Internet) application? Yes   Not Sure   No
Do you currently query the
National Practitioner Data Bank?		 Yes   Not Sure   No
Please enter any additional questions or comments:

 
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