Partner Application – Credentialing Genie

1. CONTACT INFORMATION

Full Name*

Email Address*

Phone Number*

Company Name*

Job Title

Website

2. PARTNERSHIP TYPE

Which partnership model interests you?*

Referral Partner

Refer clients and earn one-time rewards.

Strategic Partner

Access partner pricing and grow your business.

Not Sure

Help me choose the right program.

3. BUSINESS INFORMATION

What best describes your business?*

How many dental offices do you currently serve?*

Which states do you primarily serve? (Select all that apply)

California

Texas

Florida

New York

Arizona

Nationwide

Other

4. SERVICES YOUR CLIENTS NEED

Which services are your clients most likely to need? (Select all that apply)

PPO Credentialing Medicaid Enrollment New Practice Setup Re-Credentialing Medicare Enrollment Insurance Contracting CAQH Management Fee Schedule Negotiation Provider Enrollment

5. REFERRAL POTENTIAL

Approximately how many referrals could you send annually?*

Do you currently offer credentialing services?*

Yes, we do in-house

No, we do not

We outsource to another company

6. ADDITIONAL INFORMATION

Tell us about your business and how you help dental practices.

7. AGREEMENT

I certify that the information provided is accurate, agree to be contacted regarding Credentialing Genie partnership opportunities, and understand that submission of this application does not guarantee acceptance into the Partner Program.*

Your information is secure and will never be shared.

Referral Partner

Earn one-time referral rewards for every client we serve.

Strategic Partner

Access partner pricing and resources to scale your business.

Why Partner With Us?

U.S.-Based Credentialing Experts
HIPAA Compliant & Secure
Fast Turnaround Times
Dedicated Partner Support
Trusted by 1,200+ Practices

Let's Grow Together

More Patients

More Revenue

Save Time

Trusted Experts

Referral Partner

Strategic Partner

Not Sure

Referral Partner

Strategic Partner

Why Partner With Us?

Questions?