Participating in the Crescent Provider Network
A new provider must be credentialed and approved before they can be a Participating Provider in the Crescent Provider Network, and existing providers must be recredentialed every three years to remain active in the network. The Provider Credentialing process verifies licensing, training, and education of a practitioner.
The pdf-fillable forms below will assist new and existing providers to be Participating Providers in the Crescent Provider Network. Reviewing submission instructions below before beginning will save time in the approval process. A Credentialing Checklist has been included in the NC DOI Application for easy reference to documentation required.
**Please note: Humana has terminated its delegated credentialing contract with Crescent effective November 30, 2023. Please call 1-800-626-2741, to begin the credentialing process directly with Humana and to resolve claim issues.**
We do not accept CAQH applications. To export from CAQH to NC Uniform Applicaton: CAQH-TO-UNFORM APP
We thank you in advance for helping us keep our records current and notify us: 1) of credentialing contact and practice administrator contact changes or corrections, 2) when providers leave the practice, and 3) if you find a problem with one of our forms.
Add a New Provider to Practice or Recredential Participating Provider or Facility
NC DOI Uniform Application (Provider)
Facility Application
Antitrust Policy
Antitrust Guidelines
Practice W-9
New Physician Provider
Participating Physician Agreement
NC DOI Uniform Application
Antitrust Policy
Antitrust Guidelines
Insurer Amendment
Provider Demographic Sheet
Provider Fee Submission Form
Practice W-9
FORMS SUBMISSION:
Preferred, for readability and convenience to provider on future submission (other options below): Fill out electronically and save to your computer.
IMPORTANT: Missing items may delay approval date. Be sure that all forms are completed in their entirety, that explanation is provided for each “Yes” response on the Professional Information questionnaire, and that all documents listed on the Credentialing Checklist are included. Verify that the Application and all other signature pages are signed and dated, and that each provider in an applying practice has signed the Antitrust Policy & Guidelines.
Attach application, forms, and supporting documents and email to: credentialing@crescenths.com.
Or, Print and complete forms and mail or fax. Mailing Address: ATTN: CREDENTIALING, Crescent Health Solutions, 1200 Ridgefield Blvd., Ste. 215, Asheville NC 28806; FAX: 828-670-9155
Crescent’s Credentialing and Provider Relations Staff will provide further notification or request further information as necessary.
DO NOT email documents containing PHI from our website Contact page, to protect your and our members’ privacy.