Incomplete or partial applications will not be accepted.

In order for a provider application to be processed, the completed application must include all of the following documents: 

  • Caterpillar Attestation
  • Caterpillar Release of Information
  • Caterpillar PPO Healthcare NetWork Questionnaire  
  • Initial/New State of Illinois Uniform Health Care Credentialing and Data Collection form (pages 1-29 and A-F)
    Note: On page 2, signature and date are required. On forms A-F, signature and date are required if the form has been completed.
  • Results of the Self Query of the National Provider Data Bank. Here's the link to complete the self query of the National Practitioner Data Bank:
    We highly recommend that the self query be completed at the beginning of the process for the request to add a new Midlevel Provider. The receipt of the self query of the National Practitioner Data Bank report may take 10-15 days to be returned to the provider office.
  • Current copy of provider’s state professional license(s)
  • Current copy of controlled substance license (if applicable)
  • All educational certifications (including current board certification, professional school diplomas, residency and fellowship certifications as applicable)
  • Current professional liability insurance with effective and expiration dates and amount displayed per occurrence and in aggregate
  • Current copy of federal DEA license (if applicable)
  • Current W-9 for practice

Note: Services will be paid as out-of-network for Caterpillar PPO Healthcare NetWork members until the credentialing process is completed and the provider is notified of their acceptance into the Caterpillar PPO Healthcare NetWork.

Fax or email the complete credentialing application to:

Fax: 309-213-2166


 questions, contact a member of the Provider Relations credentialing team.