List of Credentialing Requirements for Connecticut:
Company Documents
- National Provider ID Number (Register here)
- DSS Enrollment (Access Here) - steps guiding through this process are attached
- Business License/Evidence/Articles of Incorporation of any Doing Business As (DBA) documentation
- Insurance Acord (Example Attached) and Insurance Endorsement (Example Attached)
- You must have General Liability and Auto Liability Insurance with limits of at least $1,000,000
- Disclosure of Ownership (Attached)
- W9 (Attached)
- Direct Deposit Form (Attached)
- Drug Free Workplace Statement (Attached)
- Company Credentialing Checklist (Attached)
Driver Documents
- Please fill out the driver list (Attached)
- Copy of Valid driver's license with “F, V, A or S” endorsement (required)
- Annual Training Certification (Attached)
- Compliance Forms (Attached)
- Evidence of PASS Training (or equivalent)
Vehicle Documents
- Please fill out the vehicle list (Attached)
- Vehicle Insurance document
- Vehicle Registration and expiration date
- Vehicle Inspection in the last 1 year
- Vehicle Credentialing Checklist (Attached)