Provider Credentialing Application

DIDD PROVIDER CREDENTIALING

DIDD and TennCare, along with MCOs, are continuing to work together in preparation for integration of the intellectual and developmental disabilities (I/DD) programs and the ultimate goal of a single, seamless, person-centered system of service delivery for people with I/DD which supports the person to increase their independence, fully participate in the communities, and achieve any competitive and integrated employment goals.

Effective immediately all applicants must submit a Provider Credentialing Application online with attachments (to include required licenses, registrations, and other documentation) in order to be reviewed and considered for credentialing through DIDD. This means all applicants, who have not yet obtained licensure or completed registration in the TennCare Provider Registration Portal, must do so prior to credentialing approval.

• Provider Credentialing Application
  
  • Instructions
  • Credentialing Standards
  • Licensing Requirements
  • Provider Credentialing Policy Req
  • 1915(c) / Katie Beckett - Part B

Additional Resources:

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

Please submit a completed application and all attachment requirements to DIDDProvider.Application@tn.gov

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