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
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
Time: 12:30 pm to 3:00 pm CST/1:30 pm to 4:00 pm EST
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Microsoft Teams meeting
Join on your computer, mobile app or room device
Click here to join the meeting
Meeting ID: 261 534 889 443
Passcode: EdqSUQ
Download Teams | Join on the web
Join with a video conferencing device
Video Conference ID: 111 536 414 5
Or call in (audio only)
+1 629-209-4396,,131002280# United States, Nashville
Phone Conference ID: 131 002 280#
Time: 12:30 pm to 3:00 pm CST/1:30 pm to 4:00 pm EST
Microsoft Teams meeting
Join on your computer, mobile app or room device
Click here to join the meeting
Meeting ID: 230 083 676 579
Passcode: 4A2tAy
Download Teams | Join on the web
Join with a video conferencing device
Video Conference ID: 116 672 312 4
Or call in (audio only)
+1 629-209-4396,,879841910# United States, Nashville
Phone Conference ID: 879 841 910#
Provider Credentialing Application
Application Submission
- See the Submission Links below, submit the application to the region you are requesting to provide the service.
- 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.
- 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.
- Please allow 30 calendar days before requesting the status of your application.
- For questions, contact the DIDD Provider Enrollment Coordinator by email at DIDDProvider.Application@tn.gov or by phone at (615) 532-6530
Submission Links:
East TN Region OwnCloud Link: https://tncloud.tn.gov/owncloud/index.php/s/xlvnxMJ64D4z0Gz
Password: upload
Middle TN Region OwnCloud Link: https://tncloud.tn.gov/owncloud/index.php/s/mHNGfeP0oq6B9Uu
Password: upload
West TN Region OwnCloud Link: https://tncloud.tn.gov/owncloud/index.php/s/PGWdmqFkXRY0XFN
Password: upload
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
- 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
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