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Information Last Updated: 6/4/2019

Brand New Day

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Provider Credentialing

Credentialing is the process of obtaining and reviewing documentation to determine participation status in a health plan. The documentation may include, but is not limited to, the applicant’s education, training, clinical privileges, experience, licensure, accreditation, certifications, professional liability insurance, malpractice history and professional competence. Generally, the terms credentialing and recredentialing include the review of the information and documentation collected, as well as verification that the information is accurate and complete.

For answers to questions regarding credentialing status or the process described below

Call: 1-800-255-4795 Ext. 2048, TTY: 711
Hours of Operation: Monday – Friday, 8am – 5pm

Credentialing Process

Brand New Day accepts the use of Council for Affordable Quality Healthcare (CAQH) ProViewTM, a service that provides a fast and easy way to securely submit credentialing information to multiple plans and networks by entering information just once. Application data can be submitted online at any time. This simplified credentialing process reduces paperwork and saves time. It is provided at no cost. Please be sure to grant Brand New Day access to the CAQH ProView application.

Brand New Day Also accepts the California Participating Physician Application (CPPA).

To become credentialed for the first time, you will need a current and complete application.

Please be sure to:

  • Complete all fields on the form or mark them N/A.
  • Include all prior and current practice locations.
  • Include identification numbers, such as the physician or provider’s Social Security number, National Provider Identifier (NPI), Drug Enforcement Agency number, unique provider ID and professional license numbers.
  • Answer all questions and provide explanations if needed.
  • Include the signed and dated attestation form.

Provide digital copies of your:

  • Curriculum vitae, including work history in a month/year format
  • Professional license or DEA certificate
  • Controlled Dangerous Substances (CDS) certificate
  • Copy of malpractice insurance face sheet
  • Summary of pending or settled malpractice cases

Credentialing Forms

Click on the buttons below to download the forms to complete your Credentialing status.

CAQH Attestation Form

FULL CPPA Application

Supervising Physician Assistant Agreement

Mid-Level Provider Application

Form Submission

Drag and Drop your files here: