Iowa Credentialing Coalition

The Iowa Credentialing Coalition (ICC) is a voluntary cooperative initiative formed in 2000 focused on easing administrative burdens associated with credentialing. Physicians and their medical practices have increasingly been using the ICC’s Statewide Universal Credentialing Application forms, and many health plans and hospitals now accept the ICC's forms. ICC members continue to explore cooperative initiatives in the field of credentialing.

Current Membership

  • Iowa Medical Society
  • Iowa Osteopathic Medical Association
  • Iowa Medical Group Management Association
  • Iowa Hospital Association
  • Iowa Association of Medical Staff Services
  • Iowa Board of Medicine
  • Iowa Federation of Insurers
  • Mercy Credentialing Service
  • Mercy of Iowa City Regional PHO
  • Midwest Oncology Practice Society
  • Paramount Health Options
  • University of Iowa Clinical Staff Office
  • Wellmark Blue Cross and Blue Shield of Iowa

Iowa Statewide Universal Credentialing Application Forms

In January 2016, the ICC released revised versions of its Iowa Statewide Universal Practitioner Credentialing Application (ISUPCA version 1.7) form and its Iowa Statewide Universal Practitioner Recredentialing Application (ISUPRA version 1.5) form. Older versions of these forms will be accepted until April 1, 2016. The Iowa Statewide Universal Facility Credentialing Application (ISUFCA version 1.1) form, which is used for both facility credentialing and recredentialing, has not been changed since April 2011.

Edits to the forms reflect recommendations by users as well as members of the ICC. A medical practice or other user that would like to suggest changes to the ICC's credentialing application forms is encouraged to submit those suggestions or other comments to the ICC for its consideration; the next review will occur in 2017. Comments may be made through the Iowa Medical Society by contacting us. The ICC also conducts annual reviews to assure the forms meet requirements of appropriate standards organizations such as the Joint Commission, NCQA and URAC as well as relevant federal and state laws and regulations.

The ICC’s credentialing application forms (ISUPCA, ISUPRA, and ISUFCA) are available in different electronic formats. ICC's credentialing application forms are copyrighted work products and protected to preclude alteration or revision by any user or other person.

2016 Edits

2016 ISUPCA Application Changes
(Microsoft Excel Workbook)