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Contracting Skilled Nursing Facility

  1. Contact your Provider Relations Representative to order your contract. (See PAP100)
  2. Submit the following items. Any missing items may result in the return of incomplete documents or a delay in processing.
    • Must be licensed by the Idaho Department of Health and Welfare (attach a copy)
    • Evidence of accreditation: Medicare Accreditation/Certification and The Joint Commission (TJC) or Commission or Accreditation of Rehabilitation Facilities (CARF)
    • Malpractice/liability insurance - minimum amounts of $1 million per occurrence, $3 million aggregate (attach a copy)
    • Provider information sheet 
    • W-9
    • Credentialing application
    • Exhibit 1
    • Provider tax ID or ownership update (This is only required when a new contract on an existing provider is required due to a tax ID or ownership updated.)

 

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Fax:  208-387-6818

Email:  PR2PI@bcidaho.com