Welcome to the Home of The Georgia Uniform Healthcare Practitioner Credentialing Application Form!

The Georgia Uniform Healthcare Practitioner Credentialing Application Form (UHPCAF) and the Georgia Uniform Practitioner Healthcare Credentialing Reappointment Form were developed through the cooperative efforts of the Georgia Hospital Association, the Georgia In-House Counsel Association, the Georgia Association Medical Staff Services and the Georgia Association of Health Plans.  In addition, the Medical Association of Georgia provided important input, consultation and collaboration.

These standardized documents were created with the objective of reducing the burdensome task of completing numerous non-standardized and redundant credentialing forms by the physicians themselves and their respective office staffs.

Updated UHPCAF Effective 7/28/03

The Georgia UHPCAF Committee has been charged with maintaining and updating the Forms as appropriate.  

The Initial (Part One), the Reappointment (Part One), and the Georgia Association of Health Plans Part Two Forms have recently been revised pursuant to a number of suggestions from healthcare entities that accept and use the Forms.  The majority of the revisions are clerical or cosmetic, and are not substantive changes.  The revisions are designed to make the Forms more user-friendly and to eliminate inapplicable choices, such as “Does Not Apply”, where they were inappropriate.

The revisions were voted on and agreed to by the members of the Georgia UHPCAF Committee at its meeting on July 28, 2003.  The application Forms dated 7/28/03 do not invalidate Forms dated 8/22/02.  The decision to continue to accept the 2002 Forms will be entity-specific.