CCPA Recredentialing Process

Here is the  CCPA Recredentialing Checklist for you to use.  This checklist was created to give you a detailed list of items needed to submit to CCPA for recredentialing.

CCPA Recredentialing Important Items

Application

• Complete EACH page of the  “STATE OF ILLINOIS Health Care Professional Recredentialing and Business Data Gathering Form.”  Please ensure that your dated signature on page two (2) of the application is current at the time your application is submitted to CCPA. CCPA will not accept an application that has been dated 30 days or more prior to the date the application is submitted to CCPA.

Support Documents Needed 

• Signed CCPA Attestation Form*
• Signed Page Two (2) of Illinois Application
• All Current Professional License(s) [i.e., State Medical License(s), etc.]          
• Current State Controlled Substance License 
• Current Board Certification Certificate
• Current Federal Drug Enforcement Administration Certificate
• Current Certificate of Insurance 
• Current Curriculum Vitae

   *Please click here to access all CCPA forms listed above. 

To view the CCPA recredentialing criteria in more detail, please review the  CCPA Credentialing Policies and Procedures.