you are eligible for privileges as a member of the Active Medical Staff
(for example, physician, dentist, podiatrist) of a TPQVO client
facility, you will need to complete the appropriate application form
listed on the
TPQVO client organizations require pre-application screening and will
not accept an application without first contacting the medical staff or
professional relations office. Please contact the healthcare
organization's office first if you have any question about your
eligibility for membership/affiliation.
will send the appropriate application for reappointment or recredentialing to
medical staff and network members according to the regional
recredentialing schedule. Therefore, these forms are not available
through this website.
Depending upon the healthcare organization to which you are applying,
forms are available for download on this page in Adobe Reader format. The forms may be
filled and printed and then sent or faxed to TPQVO for processing.
If you have any questions about
which form to use please call the healthcare
organization (TPQVO client) to which you are applying or reapplying for
File Set Up and Query Fees
There is a one-time file set up fee charged for any first time application
for initial privileges. This fee is noted on the application cover letter
describing all necessary documentation that you must send in with your
completed application. TPQVO will not begin processing your file
until this fee is paid. Also, most healthcare organizations will
not accept an application as complete without the additional items
listed on the cover letter.
Additionally, TPQVO will bill you for any primary source query fee
(i.e., graduate schools, national certification boards) charged to TPQVO
for providing a verification of your credential. You will
not be billed for information TPQVO can reuse from previous times your
file was processed for a TPQVO client facility.
If you've received an invoice from TPQVO
for query or set up fees or both, you may pay for these
by credit card via a secure payment gateway. Make
sure you have your invoice available and go to the "credit
card payment" page on this site. For more
information about TPQVO's credit card policies, you can
read these policies here.
Questions? Contact us at