Network Standards, Credentialing and Accreditations

Chiro PT OT Network Standards

Home Health Agency Network Standards

Interpreting Physician Network Standards

Non-Specialty Home Infusion Therapy Network Standards

DME O & P Network Standards

Imaging Facility Network Standard with Attachments

LAB Network Standards

EviCore Healthcare Credentialing Application Requirements

(Note: In order to receive a link to the electronic credentialing application you must first initiate Contracting. For more information on the contracting process please contact questions.netdev@evicore.com)

A complete credentialing application must include:

Fully Completed Application

EviCore Credentialing/Re-Credentialing Application (all sections completed and signed)

Required Supporting Documents

Business License
National Provider Identifier (NPI)
Medicare ID
General and Professional Liability Insurance
Radioactive Materials License (if applicable)
Roster of Interpreting Physicians and Medical Director (Radiology Network Only)
- Confirmation that all listed physicians have been credentialed (All Medical Directors; Interpreting Physicians in NY, NJ, and CT only)
Physicist Report (Radiology Network Only)
Accreditation Certificate(s) (e.g., ACR, Radsite, IAC, Joint Commission etc.)

Submission Requirements

All documents must be current, valid, and legible.
Applications missing any required component will be considered incomplete and will not proceed to review.

Self-Referral Payment Accreditation/Certification Submissions

EviCore strives to promote appropriate use of diagnostic imaging by the Health Plan’s contracted primary care physicians, specialty physicians and other health care professionals in office settings, through the administration of the Self-Referral Payment Policies. Providers wishing to update their accreditations/certifications should do so using the link below.

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