Credentialing Hints

When requesting membership to UniNet, these items are required: 

  • Exhibit 1.1 Contract Participation*
  • UniNet Healthcare Network Provider Agreement (please leave date blank on page 1)*
  • UniNet Applicant's Consent, Release and Immunity Agreement
  • DHHS Nebraska Ownership/Controlling Interest and Conviction Disclosure
  • W-9 (Request for Taxpayer Identification Number and Certification)
  • UniNet Collaborative Provider Agreement (required for APRN, CRNA, CNM, PA-C and OD)

* The provider agreement and Exhibit 1.1 are legal documents. Please do not modify them in any way. Any changes should be made on separate correspondence. 

Payment of UniNet dues and credentialing fees must be received before a file can be reviewed. Please return above mentioned documents and payment directly to UniNet Healthcare Network.

 PLEASE NOTE: You will be receiving separate paperwork from CHI Health Centralized Credentialing, including your initial credentialing application.

When completing the application, please include the following information in order to avoid delay in the credentialing process:

  • Explanation of time gaps of more than six (6) months, from completion of Medical School to present (in MM/YY format)
  • Professional practice history for the past five (5) years (in MM/YY format)
  • All questions under Professional Liability History and Practice Review/Disclosure Information must be answered, providing an explanation for any "yes" answers.

If there have been any malpractice issues, including but not limited to pending, settled cases or dismissed cases, please include a detailed, written explanation. Applications often are delayed due to lack of appropriate information regarding malpractice claims.

Please return the completed application and all supporting documentation directly to CHI Health Centralized Credentialing. Contact information will be included with your packet.

Questions? Please email our credentialing department.