Standardized Credentialing Form

• CAQH Form UCDS: Missouri has adopted the CAQH Form UCDS for credentialing purposes, effective Jan. 30, 2009.
  
  
• Please refer to current law at section 354.442.1(15), RSMo, and 20 CSR 400-7.180.
  
  
• Please review Bulletin Number 08-13.
  
  
• All HMOs and their credentialing agents are required to accept the paper CAQH Form UCDS. HMOs and their credentialing agents may accept the electronic CAQH Form UCDS. HMOs and their credentialing agents that develop their own electronic systems for gathering and storing credentialing data MUST also accept paper submission of the CAQH Form UCDS.
  
  
• Standardized credentialing form FAQ
  
  
• CAQH Form UCDS
  
  
• Fillable CAQH forms
  • Provider Application
  • Additional Specialty Supplemental Form
  • Code Lists
  • Covering Colleagues Supplemental Form
  • Disclosure Questions Supplemental Form
  • Hospital Privileges (Current) Supplemental Form
  • Malpractice Claims Explanation Supplemental Form
  • Other Relevant Education Supplemental Form
  • Other Training Supplemental Form
  • Partners Associates Supplemental Form
  • Practice Locations Information Supplemental Form
  • Professional IDs Supplemental Form
  • Professional Liability Insurance Carrier Supplemental Form
  • Professional Training/Work History Gaps Supplemental Form
  • Work History Supplemental Form
  • Faxing guidelines
    
    
• For more information about the CAQH Form UCDS, please review CAQH's website.
  
  
• Please direct any comments, questions or concerns to:

  Research analyst for credentialing

  Life and Healthcare Section

  Phone: 573-751-4363

  E-mail: LH@insurance.mo.gov