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How to become a DIDD Provider

NEW PROVIDER APPLICATIONS: Effective February 1, 2014, DIDD implemented a revised process for accepting new provider applications. Please note the Provider Expansion application process for current DIDD providers has not changed.

We recommend that you attend an Applicant Forum prior to submitting a DIDD New Provider Application. Attending the forum is not mandatory, but it may be helpful to applicants seeking information about DIDD and clarification about the process for submitting a DIDD New Provider Application.

The Applicant Forum is scheduled in each DIDD region (East, Middle and West) listed below. For your convenience, each DIDD Region presents the same agenda at each forum. The applicant is welcome to attend any forum on any date listed on one of the following tabs. 

West Region

January 31, 2018 
Time: 12:30 pm- 4:00 pm Central Standard Time

August 6, 2018
Time: 1:00pm - 4:00pm Central Standard Time

Location:
Auditorium
11437 Milton Wilson Rd,
Arlington, TN 38002

For Registration contact Linda Hall by email at Linda.Hall@tn.gov or by phone at (901)745-7553

Middle Region

February 1, 2018 
Time: 1:00 pm- 4:00 pm Central Standard Time

August 7, 2018 
Time: 1:00 pm- 4:00 pm Central Standard Time

One Cannon Way Basement Conference Room
275 Stewarts Ferry Pike
Nashville, TN 37214

For Registration contact Patricia L. Cunningham by email at Patricia.L.Cunningham@tn.gov or by phone at (615) 884-1916

East Region

February 2, 2018 
Time: 1:00 pm- 4:00pm Eastern Standard Time

August 8, 2018
Time: 1:00 pm- 4:00pm Eastern Standard Time

East Tennessee Regional Office
520 West Summitt Hill Drive
Suite 201, Palm Conference Room
Knoxville, Tennessee 37902

For Registration contact Lorene M. Kieffer by email at Lorene.M.Kieffer@tn.gov or by phone at (865) 594-9296

Provider Application for Clinical and Ancillary Services

Credentialing Application for Dental Services and/or Anesthesia Service

  • W-9 Form - must be submitted with application
  • Disclosure Form for Provider Person or Entity - must be submitted with application.
  • See Instructions for Submitting National Background Check to DIDD to the right.

Initial Screening Questionnaire for Long Term Services & Support Coordination Services / Part 1

  • Step by Step instructions for Part 1
  • W-9 Form - must be submitted with application
  • Disclosure Form for Provider Person or Entity - must be submitted with application.
  • See Instructions for Submitting National Background Check to DIDD to the right.

Application for Long Term Services / Part 2

Application for Support Coordination / Part 2

Submitting a National Background Check to DIDD

FAQs for National Background Check

 

​​​Volunteer and Employee Criminal History Agreements

  1. ​VECHS Letter
  2. VECHS Waiver
  3. How to Complete the VECHS Waiver Form

Instructions for Identogo

This Page Last Updated: March 16, 2018 at 9:48 AM