Step 1a: Credentialing Application Logo

  • Credentialing Application

  • Please complete the following forms. Once approved, we will email you a copy of your agreement and other information you might need.

    Disclaimer: This application will become part of your “Provider Agreement.”

  • Applicant Information

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  • Professional (Malpractice) Liability Carrier

  • In order to continue with the Acu-Care Network you must have Malpractice Carrier insurance with a limit of 1M/3M.

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  • Please Update Your Policy to expire at least 60 days from today.

  • Office Liability Carrier or Premesis Liability Carrier

  • In order to continue with the Acu-Care Network you must have General Liability Carrier insurance with a limit of 1M/2M.

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  • Please Update Your Policy to expire at least 60 days from today.

  • Education

  • In order to continue with the Acu-Care Network you must be a Licensed Acupuncturist with a L.Ac

  • Board Certification

  • Work History

  • Attestation Questions

  • Who Referred You to Acu-care

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  • Clinic Information

    • Clinic Information: Clinic 1 

    • Clinic #1

    • In order to continue with the Acu-Care Network your clinic email address must be different from your personal email address

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    • Clinic Information: Clinic 2 

    • Clinic #2

    • In order to continue with the Acu-Care Network your clinic email address must be different from your personal email address

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    • Location 3 Section 

    • Location 3

    • Location 4 Section 

    • Location 4

    • Location 5 Section 

    • Location 5

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  • Hiv/Aids Specialist Designation

    This legislation requires standing referrals to HIV/AIDS specialists for patients who need continued care for their HIV/AIDS.

    The Department of Managed Health Care (DMHC) recently defined an HIV/AIDS specialist under Regulation LS - 34 -01.

    In order to comply with this regulation, we need to identify appropriately qualified specialists within our network who meet the definition of an HIV/AIDS specialist.

    We will use your information for internal referral procedures and for publication listing in the Provider Directory.

    As always, if information about your practice changes, please notify us promptly.

    1. In the immediately preceding 12 months, I successfully completed a minimum of 15 hours of category 1 continuing medical education in the prevention of HIV infection, combined with diagnosis, treatment or both of HIV-infected patients, including a minimum of 5 hours related to antiretroviral therapy per year; OR
    1. In the immediately preceding 12 months, I have obtained board certification or re-certification in the field of Infectious Disease from a member board of the American Board of Medical Specialties; OR
    2. In the immediately preceding 12 months, I have successfully completed a minimum of 30 hours of category 1 continuing medical education in the prevention of HIV infection, combined with diagnosis, treatment or both, of HIV-infected patients; OR
    3. In the immediately preceding 12 months, I have successfully completed a minimum of 15 hours of category 1 continuing medical education in the prevention of HIV infection, combined with diagnosis, treatment or both, of HIV-infected patients Medicine and successfully completed the HIV Medicine Competency Maintenance Examination administered by the American Academy of HIV Medicine.

  • Non-Discrimination

    Acu-Care is committed to ensuring equal opportunity and fairness in all aspects of its credentialing and contracting processes. We do not discriminate against any applicant or provider on the basis of race, color, religion, national origin, ethnicity, age, sex, sexual orientation, gender identity or expression, marital status, disability, genetic information, veteran status, or any other protected characteristic under applicable federal or state laws.

    Additionally, Acu-Care does not discriminate against licensed providers solely due to a civil judgment, criminal conviction, or professional disciplinary action in another state if such action is based only on the application of that state’s law that interferes with a person’s right to receive care that would be lawful if provided in California.

    By submitting this application, you acknowledge that you have read and understand this non-discrimination policy.

  • Attestation

    I hereby attest that the information I have provided in this application is current, correct and complete to the best of my knowledge and belief and in good faith. I understand that material omissions or misrepresentations may result in the denial of my application. 

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