Become a Credentialed Provider
Provider Credentialing Application Forum Dates
The Provider Credentialing Forums are held quarterly, two (2) times within the same month, Central Standard Time (CST). The Forums are virtual, on the day and time of the meeting, click the meeting date and follow the detail to join.
April 23, 2026
Time: 9:00AM-12:00PM Central Standard Time
Further meeting details are to be announced
April 30, 2026
Time: 9:00AM-12:00PM Central Standard Time
Further meeting details are to be announced
1. Submit the application to DDA.Provider.Application@tn.gov
2. Type in the Subject section your organization’s name and the region (West, or Middle, or East, or Statewide*) you are requesting the service
* Statewide applies If you are applying for more than one region
3. For each uploaded document label the document’s name. See Attachment 1 for the list of appropriate documents to upload according to your selected service(s).
For Example:
- Credentialing Application
- TN Business State License and/or County of TN Business License, as applicable
- Disclosure Form
- Tax Forms (W-9, IRS 147c and Substitute W-9)
If each uploaded document is not named this may delay the downloading process and impact credentialing of your application. Graphic files such as: JPEG (photo) or TIFF, will not be accepted.
Note: Due to documentation uploading capacity limitation, you may need to continue uploads onto more than one submission. Remember for each submission, type in the Subject line type your organization’s name and the region (West, Middle, or East, or Statewide*) you are requesting the service. Also label the name of each uploaded document.
* Statewide applies If you are applying for more than one region
Note: If you decide to upload a ZIP FILE. Please ensure the uploaded file states the name of your organization and the region. Also label the name of each document within the ZIP FILE.
4. DDA will email confirmation of your application within two (2) business days. It is very important you contact DDA if you do not receive this email.
5. Please allow 30 calendar days before requesting the status of your application.
6. For questions, contact the DDA Provider Enrollment Coordinator by email at DDA.Provider.Application@tn.gov or phone (615) 532-6530
Very Important: The Prerequisites must be completed prior to submission of your Credentialing application. Please see the Prerequisites section of the application.
- Attachment 1: Credentialing Standards
- Attachment 2: Licensing Requirements
- Attachment 3: Provider Credentialing Policy Req
- Minimum Required Policies and Review Guidelines
- Attachment 4: Service Definitions (see specific program definitions below)
Submitting a National Criminal Background Check to DDA
- DDA Available Service Rates
- Katie Beckett Available Service Rates
- Title VI of the Civil Rights Act of 1964 Annual Training
If you have any questions, you may contact Linda Maurice at DDA.Provider.Application@tn.gov