Physician Pre-Application

ATTENTION MAC USERS: 

At the present time, the physician pre-application does not work on Mac platforms due to limitations of Adobe Acrobat. We apologize for any inconvenience and are working to find a solution. Please complete the application on a PC.

Piedmont Healthcare recognizes that the process to request hospital privileges can be time consuming. To alleviate the time constraints, Piedmont Healthcare has a Central Verification Office (CVO) to handle all physician applications for appointment to any Piedmont hospital. This significantly reduces the amount of time required to process an application by implementing the following key changes:

• Only one application will be required whether applying for privileges at one or more facilities
• Several processes will be automated internally, reducing the amount of time a provider needs to spend completing the required documents
• Credentials are verified centrally instead of by each facility

Click here to start the Pre-Application process.

If you are interested in learning more, the following process flow describes what you can expect at various stages:

Credentialing Process

Step 1:
For initial requests for privileges at a Piedmont facility, a provider completes an online pre-application form. Only one application is required whether applying for privileges at one or more facilities. Once completed, the provider may submit the form electronically and print for his or her records.

Step 2:
Once the pre-application has been submitted, the provider will be contacted by the Central Verification Office confirming that the application was submitted successfully. The pre-application is then reviewed by each Medical Staff Office (MSO) for which he or she is requesting privileges.

Step 3:
The provider is notified via email whether the pre-application has been approved for processing.

Step 4:
Once the pre-application is approved, a member of the Central Verification Office (CVO) will contact the applicant via email with all necessary documents needed by the CVO to begin the application process.

Step 5:
Before the credentialing process can begin, the provider must submit all supporting documentation regarding education, licensure, board certification, malpractice insurance, references, and sign all pages needed for the credentialing process. Once the application and supporting documentation have been received, the process will begin.

Step 6:
Once the CVO completes primary source verification of the provider's credentials, a complete file is sent to the MSO for review and submission to the Credentialing Committee, Medical Executive Committee and Hospital Board. The decision to grant or deny privileges is made based on the specific experience, training, and demonstrated competency of the physician under review.

Click here to start the Pre-Application process.

The documents listed below are for your information. It is not necessary to sign and return any of these documents.

• Piedmont Hospital - ByLaws, Policies and Rules and Regulations 
• Piedmont Hospital - Credentials Policy 
• Piedmont Hospital - Liability Insurance Requirements 
• Piedmont Fayette Hospital - ByLaws, Policies and Rules and Regulations 
• Piedmont Fayette Hospital - Credentials Policy 
• Piedmont Fayette Hospital - Liability Insurance Requirements 
• Piedmont Mountainside Hospital - ByLaws, Policies and Rules and Regulations 
• Piedmont Mountainside Hospital - Credentials Policy 
• Piedmont Mountainside Hospital - Liability Insurance Requirements 
• Piedmont Newnan Hospital - ByLaws, Policies and Rules and Regulations 
• Piedmont Newnan Hospital - Credentials Policy 
• Piedmont Newnan Hospital - Policy on Allied Health Professionals 

• Piedmont Promise
• Vision, Mission, Values 

Contact Information for Initial Appointment

PHC Central Verification Office
Credentialing Assistant: Mara Haynes
Telephone: 770-801-2730
Department E-mail: PHC-CVO@piedmont.org 
Department Fax #: (404) 588-2630