CHCPCA Application

On April 14, 2004, Colorado Governor Bill Owens signed into law House Bill 04-1354, known as the Health Care Credentials Uniform Application Act. The purpose of the Act is "...to make credentialing more efficient, less costly, and less duplicative by making it uniform through the use of a single application form for the collection of core credentials data...". The Colorado Health Care Professional Credentials Application (CHCPCA) became effective for initial credentialing in Colorado January 1, 2006. Effective May 1, 2006, the Colorado Department of Public Health and Environment announced that the same form shall be effective for re-credentialing in Colorado as well.

This application when completed should be provided/forwarded to the appropriate Credentialing entity upon request.

* Current version was amended December 18, 2013; it became effective February 14, 2014.

Colorado Physicians and Health Care Professionals Insured by COPIC

To access the CHCPCA application, just click on the "Service Center" button and enter your COPIC log-in information. Once you complete the application and save it, COPIC will store it online so you can make future updates as necessary.

Colorado Physicians and Health Care Professionals Not Insured by COPIC

If you are not currently insured and not applying to COPIC for coverage, you can still access a blank copy of the CHCPCA application. Get the Microsoft Word 2002 or later version or the PDF version.

Microsoft Word format—Using Microsoft Word 2002 or later, open the application, type in your answers, and save it on your computer or system for future printing and updating.

PDF format (1.2 MB file)—Using a full (i.e., purchased) installation of Adobe Acrobat Standard, open the application, type in your information, and save the completed copy to your computer or system for future printing and updating. Using the free Adobe Reader, open the application, type in your information, and print a completed copy. You will not be able to save a completed copy to your computer or system, and your information will be erased when you close the file.

Contact Us

Contact us with questions regarding content in the CHCPCA application.

Al Schwindt

aschwindt@copic.com

720.858.6038

800.421.1834, ext. 6038

Applications

Downloadable CHCPCA Applications