This form was promulgated by industry representatives in cooperation with provider
representatives to amend and reenact R. S. 22:1009(E) in accordance with Act 671 of the
2004 legislative session and Act 374 of the 2005 legislative session.
The Physician's Credentialing Form and the contents therein are not the product of the Louisiana Department of Insurance. This Physician Credentialing Form, along with the Provider Application link to the current format used by the Council for Affordable Quality Healthcare (CAQH) is posted on our website as a courtesy to industry
Click here to view form.
Click here to access the link.