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Uniform Provider Credentialing

Under 18 V.S.A. § 9408a, enacted during the 2006 Session of the Vermont General Assembly, the department was required to prescribe a uniform provider credentialing application form for use by all insurers and hospitals in Vermont when credentialing health care providers, effective January 1, 2007. Department Bulletin #122 prescribes the use of the CAQH’s provider credentialing application form for primary source credentialing and recredentialing, outlines how it is to be used and describes enforcement authority and the effective date. 

Bulletin #122

CAQH Credentialing Application Form

Link to CAQH’s website:

If you do not have Internet access, you can call the CAQH Help Desk at 888-599-1771 and request an application be sent by mail. 

Please note that each insurer and/or hospital may require supplemental credentialing requirements in addition to those outlined on the CAQH application form.