Credentialing Forms

A new provider must be credentialed and approved before they can be a Participating Provider in the Crescent Health Solutions 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 Health Solutions Provider Network. Reviewing the 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 the documentation required.


**Please note: Humana has terminated its delegated credentialing contract with Crescent Health Solutions 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

New Physician Provider

New Facility

New Allied Health Provider

Form submission information: 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:


You may also print and complete forms and mail to:
Crescent Health Solutions
1200 Ridgefield Blvd., Ste. 215
Asheville NC 28806


or FAX to: (828) 670-9155


Crescent Health Solutions’ 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.