To complete the credentialing process, providers will need to send Health Wise Credentialing Solutions the following documents:
- Practitioner License(s)
- Malpractice Insurance (Certificate of Insurance)
- DEA (federal) and state CSR certificates (if applicable)
- Board Certification(s)
- Diploma – copy of highest level of education (Master’s degree, PA, DPT, etc.)
- 5 years of work history, if not uploaded in CAQH
- IRS Form W-9* Taxpayer Identification Verification Form (https://www.irs.gov/pub/irs-pdf/fw9.pdf)
- IRS form CP575 or replacement letter 147C (verification of EIN)
- Copy of office lease (required for independent therapy facilities to enroll with Medicare)
- Bank account verification – a voided check with the business name, which must be exactly as shown on the IRS CP575 or a letter from your bank on letterhead verifying your bank account. The business name must be exactly as it is on file with the IRS, which includes: punctuation, abbreviations, etc.
