How to Get Credentialed with Workers' Compensation in Maine
Quick Overview
Timeline
14 - 60 days
CAQH
Not Required
Re-credentialing
Every 3 year(s)
Delegated
No
Maine-Specific Requirements
Step-by-Step Enrollment Process
Gather Required Documents
Collect all necessary credentials including your medical license, DEA certificate, malpractice insurance, NPI number, and any state-specific requirements for Maine.
Prepare Your Application
Complete Workers' Compensation's provider enrollment application with all required information and supporting documentation.
Submit Your Application
Submit your completed enrollment package to Workers' Compensation.
Track & Follow Up
Credentialing typically takes 14-60 days. Monitor your application status and respond promptly to requests for additional information.
Required Documents Checklist
DEA License
ConditionalRequired if prescribing controlled substances
Malpractice Insurance
Current professional liability insurance
Medical License
Active state medical license in the state where treatment is provided
NPI Certificate
National Provider Identifier required for billing
W9_FORM
IRS W-9 for tax reporting and payment setup
Enrollment Forms
OWCP-1168 Provider Enrollment Form
Federal workers compensation provider enrollment form for the Office of Workers Compensation Programs.
RequiredState Workers Compensation Provider Registration
State-specific provider registration form for participation in state workers compensation programs.
RequiredFirst Report of Injury (FROI)
Universal workers compensation claim form used to document and report initial workplace injury or illness.
Contact Information
US Dept. of Labor - OWCP
National1-866-487-2365
Provider Enrollment - State-Specific
NationalClaims - State-Specific
National