Become a Health Right Provider
To start the process of becoming a Health Right provider please review the checklists listed below, fill out and then return all of the necessary documents.
Click on the document below that you wish to view
Provider Application
Provider Letter: credentialing checklist
Ancillary Organization credentialing application
Ancillary Provider Letter: credentialing checklist
C-A-Q-H form
W-9 Tax Form
Declaration of signature authority
Transportation review process and checklist
We accept CAQH application along with required documentation attestation. The website for CAQH is:https://upd.caqh.org
Credentialing/Recredentialing
The appropriate and regular credentialing and recredentialing of network practitioners and providers, as defined by HRI policies and procedures is a key function of both the Credentialing Committee and the Quality Management Program. All practitioners participating within Health Right's network undergo a review of their qualifications, including education and training, licensure status, board certification, malpractice history, etc. All practitioners undergoing initial credentialing and recredentialing are reviewed and approved by the Credentialing Committee. Credentialing and recredentialing activities, minutes and documents are considered privileged and confidential under state and federal laws.
The following documents are required for credentialing along with the Provider Application:
Current valid District of Columbia License.
Copy of current malpractice insurance certification.
Copy of current Drug Enforcement Administration (DEA) Registration Certificate
Curriculum Vitae.
Copy of Medical School Diploma. (if not Board Certified)
Copy of Internship and Residency Certification. (if not Board Certified)
Copy of JCAHO, ADA, or other Accreditation Certificate, if applicable.
Copy of Board Certification/Board Eligibility Letter, if applicable.
Copy of Educational Committee for Foreign Medical Graduates Certificate (ECFMG), if applicable.
Work history, last three years.
Professional liability claims history.
Loss of license or felony convictions.
History of loss or limitation of privileges or disciplinary activity.
Attestation to the correctness/completeness of the application.
Professional peer references, concerning the individual's professional performance, judgment, and clinical or technical skills.
The recredentialing process shall include all of the steps in the credentialing process with the exception of the verification of primary medical education, internship and resident training.
To start the process of becoming a Health Right provider please review the checklists listed below, fill out and then return all of the necessary documents.
Click on the document below that you wish to view
Provider Application
Provider Letter: credentialing checklist
Ancillary Organization credentialing application
Ancillary Provider Letter: credentialing checklist
C-A-Q-H form
W-9 Tax Form
Declaration of signature authority
Transportation review process and checklist
We accept CAQH application along with required documentation attestation. The website for CAQH is:https://upd.caqh.org
Credentialing/Recredentialing
The appropriate and regular credentialing and recredentialing of network practitioners and providers, as defined by HRI policies and procedures is a key function of both the Credentialing Committee and the Quality Management Program. All practitioners participating within Health Right's network undergo a review of their qualifications, including education and training, licensure status, board certification, malpractice history, etc. All practitioners undergoing initial credentialing and recredentialing are reviewed and approved by the Credentialing Committee. Credentialing and recredentialing activities, minutes and documents are considered privileged and confidential under state and federal laws.
The following documents are required for credentialing along with the Provider Application:
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