Complete Grow's credentialing form
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Alexis Reichler

Created Jun 07, 2022

Complete Grow's credentialing form

1297
1

Go to Grow's credentialing form

Go to Grow's credentialing form
2

Input your legal first, last, and middle name

Also input other names (ie. maiden or alias)

Input your legal first, last, and middle name
3

Enter your phone number

Enter your phone number
4

Input the email that Grow has on file for you

Input the email that Grow has on file for you
5

Enter your home address ( street address, city, state, zip code)

Enter your home address ( street address, city, state, zip code)
6

Select if you have a different mailing address

Select if you have a different mailing address
7

Enter your date of birth

Enter your date of birth
8

Select your gender identification

Select your gender identification
9

Upload your most updated resume

This must be in PDF, DOC, DOCX, or JPG file form

Upload your most updated resume
10

Click on Next

Click on Next
11

Enter your individual NPI number

Enter your individual NPI number
12

Select the states in which you hold active licenses

Select the states in which you hold active licenses
13

Select if you are an NP, MD, or DO

Select if you are an NP, MD, or DO
14

Enter EACH of your state(s) license numbers and your license type in that state

Enter EACH of your state(s) license numbers and your license type in that state
15

Click on Next

Click on Next
16

Read over Grow's malpractice requirements

Ensure that your policy is in line with Grow's requirements

Read over Grow's malpractice requirements
17

Select "Yes" or "No" to the following questions

Select "Yes" or "No" to the following questions
18

Input your malpractice insurance expiration date

Input your malpractice insurance expiration date
19

Upload your malpractice insurance certification

This file must be in JPG, JPEG, PDF, or PNG format

Upload your malpractice insurance certification
20

Click on Next

Click on Next
21

Select "Yes" or "No" to Medicare/Medicaid enrollment questions

Medicare enrollment is only open to the following license types: LCSW, NP, PsyD, PhD, MD, or DO

Select "Yes" or "No" to Medicare/Medicaid enrollment questions
22

Select "Yes" or "No" to the following questions if applicable

Select "Yes" or "No" to the following questions if applicable
23

Click on Next

Click on Next
24

Please answer the following question honestly

Please answer the following question honestly
25

If you selected "yes" to the previous question, select which insurances you have conflicts of interest with

If you selected "yes" to the previous question, select which insurances you have conflicts of interest with
26

Select "Next"

27

Enter your CAQH number

Enter your CAQH number
28

Answer the following questions regarding your CAQH profile

Answer the following questions regarding your CAQH profile
29

Confirm if your CAQH information and disclosures are true and if you have uploaded your attestation and COI to your CAQH

Confirm if your CAQH information and disclosures are true and if you have uploaded your attestation and COI to your CAQH
30

Enter your CAQH username and password

By giving us your CAQH login information, our team is able to update any Grow-related information so that you do not have to

Enter your CAQH username and password
31

Hold down your mouse in the empty box and sign your name

Hold down your mouse in the empty box and sign your name
32

In order to complete the credentialing form, you must click "Submit"

In order to complete the credentialing form, you must click "Submit"
33

Congratulations on kicking off the credentialing process!

If your form has been submitted correctly, you will receive this email notifying you of your submission.

Congratulations on kicking off the credentialing process!
Well done!
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