4201.1 Each health insurer or its credentialing intermediary, and § 44-501(a) entities shall accept the current credentialing/re-credentialing form attached to this chapter as Appendix 39-1 as the sole application for credentialing and re-credentialing of a healthcare provider for participation on a provider panel.

4201.2 A copy of the “Provider Application” may be obtained from the department.

4201.3 The “Provider Application” form is available in hard copy and on-line at the department’s website at www.disr.dc.gov

Source: Notice of Final Rulemaking published at 53 DCR 6531 (August 11, 2006).