We highly recommend the use of CAQH if you have an active account. CAQH is a FREE tool for physicians and mid-level providers. Please download a copy of your CAQH provider profile and submit it to EPMN with the following documentation.
- Participating Practice Agreement
- Business Associate Agreement
- IRS Form W-9 (make sure the information you provide on this form is identical to the information the IRS provided when they issued your federal employer identification number)
- Texas Workers’ Compensation Required Information Form
- Supplemental Credentialing Information Form
- Texas Standard Credentialing Application
All done?
Submit your COMPLETE package by:
-
U.S. Mail or Overnight Delivery Services:
EPMN Credentialing Verification
Cypress Healthcare Consultants
500 N Central Expressway, Suite 500
Plano, TX 75074 - EMAIL (Scanned Copies): EPMNCred@cypresshcc.com
- Fax: (469) 757-8883
INCOMPLETE APPLICATION PACKETS CANNOT BE PROCESSED. THERE WILL BE NO EXCEPTIONS.
Your Application Packet must contain:
- A completed Application – all aspects of the Application must be complete or marked “not applicable.” Blanks without explanation will not be accepted and will result in a rejected application.
- 100% of the Supporting Documentation required to accompany your Application.
- 100% of your Supporting Documentation must be current. If ANY documentation is expired, your Application will be rejected as incomplete.
Questions?
If you have any questions or need some help with your application process, feel free to contact us at (972) 424-1360.
Refund Policy
In the event your Application is not approved for any reason, your Membership Dues will be returned to you. Credentialing Fees are non-refundable.
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