HMO Standardized Credentialing Form | Missouri Department of Insurance

CAQH Form UCDS

Missouri has adopted the CAQH Form UCDS for credentialing purposes, effective Jan. 30, 2009.

Refer to current law at section 354.442.1(15), RSMo, and 20 CSR 400-7.180.
Review Bulletin No. 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.

For more information about the CAQH Form UCDS, see CAQH's website.

Fillable CAQH Forms

Provider Application

Additional Specialty Supplemental Form

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

Contact Us

Direct any comments, questions or concerns to research analyst for credentialing in Life and Healthcare Section:

Phone: 573-751-7470

Email: ProductFilings@insurance.mo.gov