How to Become a Credentialed Provider for:

• Katie Beckett - Part A
• Katie Beckett - Part B
• 1915c
• Employment and Community First (ECF) CHOICES
• ECF Provider who provide CHOICES Waiver Services

Credentialing Protocol

Presentation: How to become a Credentialed Provider

Provider Credentialing Application Forum Dates

The Provider Credentialing Applicant Forums are scheduled two (2) times within a quarter at the same time 12:30 pm to 3:00 pm CST / 1:30 pm to 4:00 pm EST

Provider Credentialing Application

Application Submission

1. See the Submission Links below, submit the application to the region you are requesting to provide the service. 
2. If requesting to provide services in multiple regions, submit the application to the region in which your main office is located. 
   • Note: When naming your application include the name of your organization as part of the title in the uploaded document each time you submit information. Example:  ABC application, ABC background checks, ABC Disclosure form, etc.
   • Note: If you decide to upload a ZIP FILE. Please ensure the file states the name of your organization.
3. DIDD will email confirmation of your application within two (2) business days. It is very important you contact DIDD if you do not receive this email.
4. Please allow 30 calendar days before requesting the status of your application. 
5. For questions, contact the DIDD Provider Enrollment Coordinator by email at DIDDProvider.Application@tn.gov or by phone at (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.  

• New Provider Credentialing Application
• Expansion Credentialing Application
• MCO Contract and County Expansion Request Form
  • Attachment 1: Credentialing Standards
  • Attachment 2: Licensing Requirements
  • Attachment 3: Provider Credentialing Policy Req
  • Attachment 4: Service Definitions
    • Katie Beckett - Part A
    • Katie Beckett - Part B 
    • 1915(c)
    • ECF CHOICES 
    • CHOICES

• Disclosure Form for Provider Person
• Disclosure Form for Provider Entities
• Substitute W9
• W-9 Form
• TN Non-Residential Self-Assessment
• TN Residential Provider Self-Assessment
• Submitting a National Criminal Background Check to DIDD
  • Frequently Asked Questions
  • Noncriminal Justice Applicant’s Privacy Rights
  • IdentoGO Tennessee Instructions
  • VECHS-Waiver Form

Additional Resources:

• DIDD Available Service Rates
• Katie Beckett Available Service Rates
• Title VI of the Civil Rights Act of 1964 Annual Training
• Minimum Required Policies & Review Guidelines

If you have any questions, you may contact Linda Maurice at DIDDProvider.Application@tn.gov