How to Become a Credentialed Provider for:
- 1915c
- Employment and Community First (ECF) CHOICES
- Katie Beckett - Part B
Presentation: How to become a Credentialed Provider
Provider Credentialing Application Forum Dates
The Provider Credentialing Applicant Forums are scheduled two (2) times within a quarter at the same time 12:30 pm to 3:00 pm CST / 1:30 pm to 4:00 pm EST
February 21, 2023, Applicant Forum
Time: 12:30 pm to 3:00 pm CST / 1:30 pm to 4:00 pm EST.
Microsoft Teams meeting
Join on your computer, mobile app or room device
Click here to join the meeting
Meeting ID: 259 804 918 736
Passcode: 8Pmo4D
Download Teams | Join on the web
Or call in (audio only)
+1 629-209-4396,,943743318# United States, Nashville
Phone Conference ID: 943 743 318#
February 28, 2023, DIDD Applicant Forum
Time: 12:30 pm to 3:00 pm CST / 1:30 pm to 4:00 pm EST.
Microsoft Teams meeting
Join on your computer, mobile app or room device
Click here to join the meeting
Meeting ID: 215 454 369 197
Passcode: 5Ay7E9
Download Teams | Join on the web
Or call in (audio only)
+1 629-209-4396,,899520364# United States, Nashville
Phone Conference ID: 899 520 364#
Please check back for Provider Credentialing Application Forum Dates scheduled during the 2023 year.
Provider Credentialing Application
Very important: Please see the Prerequisites section of the Instructions for NEW Credentialed Provider Applications below. The Prerequisites must be completed prior to submission of the Provider Credentialing Application.
- Provider Credentialing Application
- Instructions for NEW Credentialed Provider Applications
- Instructions for Expansion Applications
- Attachment 1: Credentialing Standards
- Attachment 2: Licensing Requirements
- Attachment 3: Provider Credentialing Policy Req
- Attachment 4: Service Definitions
- Disclosure Form for Provider Person
- Disclosure Form for Provider Entities
- Substitute W9
- W-9 Form
- TN Non-Residential Self-Assessment
- TN Residential Provider Self-Assessment
- Submitting a National Criminal Background Check to DIDD
Additional Resources:
- DIDD Available Service Rates
- Katie Beckett Available Service Rates
- Title VI of the Civil Rights Act of 1964 Annual Training
- Minimum Required Policies & Review Guidelines
Please submit a completed application and all attachment requirements to DIDDProvider.Application@tn.gov
If you have any questions, you may contact Linda Maurice at DIDDProvider.Application@tn.gov