Credentialing Application and Update Form

SC Uniform Managed Care Provider Credentialing Application and South Carolina Uniform Managed Care Practitioner Credentials Update Form
 
UCA 2005 Form - This form will be used for the initial credentialing of a practitioner. You can either key the information in on the computer and print the completed application, or, print the application off and fill it in by hand. Please note that if the information is keyed in on the computer, you can save only save the original form (your changes will not be saved).

UCA 2005 Form Update - This form will be used to update the information submitted in the initial application. As with the initial application, you can either key the information in on the computer and print the completed application, or, print the application off and fill it in by hand. Please note that if the information is keyed in on the computer, you can only save the original form (your changes will not be saved).
 
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Please note the Following:
  1. You will not be able to modify any of the pretyped document.
  2. To download a form, right click on the link and select "save target as" or "save as," depending on your browser. "