Please download the appropriate form, complete and mail to LifeSynch® with the indicated check-off list and required items. You may also apply via the CAQH application process.
Directions for Applying
Please review the step-by-step directions below.
Review the Required Qualifications Before Applying
Step 1. Download and Complete the Form for the State Where You Practice
Download the form for the state where you practice.
* Providers in Indiana, Rhode Island, Vermont, Washington, D.C., may not use the general credentialing form. They must submit a copy of their CAQH application for credentialing.
Step 2: Mail the Application, Check-list and Indicated Documents to LifeSynch
Mail the check-off list and required items
LifeSynch Candidate Review Process
LifeSynch notifies candidates via mail once the review process, which may take up to 120 days, is completed. As part of the review process, LifeSynch must verify your license, malpractice insurance, educational degrees, and hospital privileges, (physicians). The National Practitioner Date Bank is queried for malpractice settlements, license suspensions, and Medicare sanctions. The final step is review by LifeSynch's Credentialing Committee.
Practitioners have the right to review information submitted to support their credentialing application, correct erroneous information, and receive information about the status of their application. These rights may be exercised by calling our Provider Relations Department at 1-800-890-8288.
Contact Provider Services at 1-800-890-8288 between 8 a.m. and 5 p.m., Central Time, Monday-Friday.