Are you a participating provider? Remember to contact us any time you have changes to your credentialing or demographic information.
Some common updates include:
- Change in board certification (new, expired, etc.)
- Change in hospital staff membership
- New practitioner joined your group
- Practitioner left your group
- Moved to a new practice location
- Added or closed a group location
- Phone or fax number changes
- Tax ID number change
The following forms are available for download in DOC and PDF formats.
Please Note: Providers have the right to review information the OSF Direct Access Network obtained to evaluate credentialing or re-credentialing applications. This includes information obtained from outside sources (e.g., malpractice insurance carriers, state licensing boards) with the exception of references, recommendations or other peer review protected information.
Not a Participating Provider?
Not a participating provider but would like to apply? The first step is to provide us with some information on your practice or facility.
Please complete the Request for Participation Form provided below and send it to us to initiate the contracting process.
All providers must undergo our credentialing process prior to final participation approval.