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Provider Recredentialing

Recredentialing for participating network practitioners occurs every three years. When requested, providers must submit the appropriate application along with all required documentation to the credentialing team. If a provider’s recredentialing is past due or due within 60 days, a new enrollment application is required.

It is important to ensure the appropriate office contact information is on file so that outreach notifications are not missed. If your practice needs to update contact information, please submit a support case through the My Provider Enrollment Portal. If contact details vary by location, be sure to include the specific information for each site.

Forms

Medical Recredentialing

South Carolina Uniform Managed Care Application

The following items must be included with the application:

  • Copy of State license(s)
  • Current copy of Drug Enforcement Administration (DEA) registration (if applicable)
  • Current copy of malpractice insurance (Minimum of $1M/$3M)
  • Copy of Board Certification (if applicable)
  • Copy of Clinical Laboratory Improvement Amendment (CLIA) certification (if applicable)

Dental Recredentialing

Dental Provider Recredentialing Application

The following items must be included with the application:

  • Copy of State Dental license(s)
  • Current copy of DEA registration (if applicable)
  • Current copy of malpractice insurance (Minimum of $1M/$3M)
  • Copy of Board Certification (if applicable)

Behavioral Health Recredentialing

Behavioral Health Provider Recredentialing Application

The following items must be included with the application:

  • Copy of State license(s)
  • Current copy of DEA registration (if applicable)
  • Current copy of malpractice insurance (Minimum of $1M/$3M)
  • Copy of Board Certification (if applicable)
  • Copy of protocols (Collaborative Agreement)
  • Only for nurse practitioners

How to Submit

Submit the application and required documents to our credentialing team using one of the following methods: