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
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
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