Third Party Payor Enrollment - NPI and CAQH
Third Party Payor Enrollment - NPI and CAQH
Provider Name ______
The following are additional credentialing requirements not included on your Colorado State Credentialing Application.
For your Medicare online application, we will need your NPI user name and password.
Username______
Password ______
If you do not know your NPI user name and password, you can obtain the information on pecos.cms.hhs.govunder User Login. Follow the prompts for “Forgot User ID” and/or “Forgot Password” if you know your User ID. You can also call the NPI Enumerator at 800-465-3203. This can only be done by the provider. You will be asked identifying information in order to receive the above information. This could include your Social Security number, Date of Birth, Co State license number or other information in order to identify you. If they give you a temporary password, please write that above and add beside it what you wish your new password to be.
PLEASE NOTE: PECOS REQUIRES THAT YOUR PASSWORD BE CHANGED EVERY 60 DAYS.
By initialing below, credentialing staff has permission to update my NPI password as necessary.
Initial ______Date ______
**Any changes in NPI password will be relayed to the provider**
**CAQH is not applicable for hospital based providers. Log in information is not required for Pathologist, ER providers, Radiologist, Anesthesiologist/CRNA’s and Hospitalists**
Most of our payers use CAQH for credentialing. CAQH, Council for Affordable Quality Healthcare, provides an online database for providers and payers to make the credentialing process more efficient. We will need your CAQH Provider ID, user name and password.
CAQH Provider ID ______
Username______
Password______
If you do not know you CAQH Provider ID, user name and password, please contact CAQH at 888-599-1771. This information can only be obtained by the provider. Again, you will be asked identifying information in order to obtain your CAQH provider ID, user name and password.
By initialing below, credentialing staff has permission to update my CAQH password as necessary.
Initial ______Date ______
**Any changes in CAQH password will be relayed to the provider**
Thank you!