State of Illinois Credentialing

 

The Caterpillar Healthcare PPO NetWork requires providers to submit the State of Illinois mandated Credentialing & Recredentialing documents. These documents (the Health Care Professional Credentialing and Business Data Gathering Form and the Health Care Professional Recredentialing and Business Data Gathering Form), are available on the Illinois Department of Public Health website:

Health Care Professional Credentialing form 

Health Care Professional Re-Credentialing form

It's important to complete all pages of the documents. The PROFESSIONAL HISTORY: CONFIDENTIAL section should be reviewed closely. Any “YES” answers marked in this section must have a supporting Form A, B, C, D, E, F as required.

If the documents aren't completed correctly, the application process for in-network status will be delayed.


QUESTIONS?

For assistance or information on how to complete the credentialing or recredentialing application, contact:

Illinois Department of Public Health
Division of Health Facilities & Programs
535 West Jefferson Street, 4th Floor
Springfield, Illinois 62761

Phone: 217-782-4977

Fax: 217-782-0382

Email: DPH.MAILUS@illinois.gov