How to Become a DIDD Credentialed Provider

DIDD PROVIDER CREDENTIALING

Provider Credentialing Application Forum Dates

The Provider Credentialing Applicant Forums are scheduled two (2) times within a quarter at the same time 1:00pm to 3:00pm CST / 2:00pm to 4:00pm EST.  

August 2, 2022, Application Forum

Time:  1:00pm to 3:00pm CST / 2:00pm to 4:00pm EST.  
Join on your computer or mobile app 

Click here to join the meeting

Or call in (audio only) 
+1 629-209-4396,,275740959#   United States, Nashville 
Phone Conference ID: 275 740 959#

August 16, 2022, Application Forum

Time:  1:00pm to 3:00pm CST / 2:00pm to 4:00pm EST.  
Join on your computer or mobile app 

Click here to join the meeting

Or call in (audio only) 
+1 629-209-4396,,146817471#   United States, Nashville 
Phone Conference ID: 146 817 471#

Please check back for future web meetings scheduled:  November 2, 2022 ,and November 15, 2022.

How to Become a DIDD Credentialed Provider

• Presentation: How to become a DIDD Credentialed Provider

Provider Credentialing Application

Very important: The following must be completed prior to submission of the Provider Credentialing Application:

1. SERVICE/PROFESSION LICENSES a. PROFESSIONAL LICENSE(S)/CERTIFICATIONS: Applicable professional licenses pertain to services in the Clinical category. For example, when applying to provide Physical Therapy, the applicant must submit the therapist’s professional license. b. SERVICE LICENSE(S): Applicable service licenses pertain to residential, day, personal assistance, and other services. For example: in the Residential category, the applicant must submit the required residential license from DIDD’s licensure Division. c. PROFESSIONAL SERVICES SUPPORT LICENSE (PSSL): This is applicable to clinical services and is issued by the Tennessee Department of Health. *PLEASE NOTE: this license is not issued until after the completion of the credentialing process and therefore a copy is not required during credentialing. However, this must be obtained and uploaded before your contract may be executed.

2. FEDERAL TAX ID: This is issued by the Federal Government’s Internal Revenue Service. Please visit their website for instructions and questions.

3. REGISTRATION WITH THE TENNESSEE SECRETARY OF STATE: Please visit the Tennessee Secretary of State website to register your business. Status is required to remain “Active” while the business is open and conducting business.

• 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
  • Katie Beckett - Part B Service Definitions & Implementation
  • 1915(c) Service Definitions & Implementation
  • ECF Choices Definitions & Implementation

• 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
  • Frequently Asked Questions
  • Noncriminal Justice Applicant’s Privacy Rights
  • IdentoGO Tennessee Instructions
  • VECHS-Waiver Form

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