Paper Credentialing

Please review the application checklist below to ensure you complete and provide all the necessary documents required for the paper credentialing process, in addition to the Credentialing Application, attestation, and W-9 listed below. Please submit all the required documents to First Choice VIP Care via secure email or by fax to 1-717-651-1673.

Credentialing forms

  • Application checklist for providers not affiliated with CAQH (PDF).
  • Credentialing Application (PDF) (PA Standard Application).
    Completing and/or submitting the First Choice VIP Care Credentialing Application does not guarantee participation in the First Choice VIP Care provider network. Note: If you are joining an existing First Choice VIP Care participating group or health care facility and you would like to become a participating provider, please use the Credentialing Application (PDF).
  • Credentialing Warranty Attestation (PDF).
  • W-9 Form (PDF).

Documents and information

Providers