Thank you for participating with Guardian and being part of our network of quality providers.
As a contracted provider, you have agreed to participate in the Guardian re‐credentialing program and adhere to the same criteria and professional standards that you demonstrated at the time you were initially credentialed. Guardian re‐credentials providers on a thirty‐six (36) month cycle and our records indicate your file is due for re‐credentialing.
You will need to:
- Complete and submit the applicable re-credentialing application.
- If your state is listed below as a state that mandates the use of CAQH, you will also need to complete and submit the Guardian Authorization and Release Form.
- If you are participating in our Avesis network of Government programs, you will additionally need to complete and submit a Disclosure of Ownership.
- Submit a copy of your valid certificate of insurance.
- Submit everything via:
1. Recredentialing application
Some states mandate the use of a state specific application or the use of CAQH. If the state in which you practice is listed below, please click on the state to access the applicable application. If you practice in a state that mandates the use of CAQH, you will be directed to the CAQH ProView website. If your state is not listed, please select “All Other States” for the Guardian Credentialing Application.
State Mandated Forms:
CAQH Mandated Forms (also complete the Authorization and Release Form below):
Guardian Authorization and Release Form (for all CAQH mandated states)
Standard Guardian Form:
2. Disclosure of Ownership
If you participate in our Avesis (Government) Programs, you will need to complete a Disclosure of Ownership. Please select the appropriate form for your state.
Standard Disclosure of Ownership (All Other States)