Provider Recredentialing

Recredentialing for our providers occurs every three years. When requested, submit the following application and required documents to our credentialing team.

Form

South Carolina Uniform Managed Care Application

The following items must be included with the application:

  • Copy of State license(s)
  • Current copy of Drug Enforcement Administration (DEA) registration
  • Current copy of malpractice insurance (Minimum of $1M/$3M)
  • Copy of Clinical Laboratory Improvement Amendment (CLIA) certification

How to Submit

Submit the application and required documents to our credentialing team using one of the following methods:

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