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CGHN Pre-Application for Membership

Thank you for your interest in joining Central Georgia Health Network (CGHN). As part of our process, all potential members are required to complete this pre-application. Please know that all pre-applications are presented to the CGHN Provider Relations Committee and approval of this application does not guarantee CGHN membership. Final determination will come after Board approval and completion of credentialing process.

Please complete the fields below and click "Submit" when complete.

I understand that the minimal standards for CGHN membership requires a current GA Medical License, appropriate hospital privileges, a current DEA or proof of DEA coverage, malpractice insurance with a minimum of $1M per claim/$3M per annual aggregate, board certification, and appropriate call coverage.

I understand

CGHN is a clinically integrated network (CIN) and therefore all providers who wish to join must attest that he/she is capable of meeting requirements set forth. The primary characteristics of a CIN include; having physicians play a key leadership role, commitment to comply with clincial guidelines, strategically use data and technology and demonstrate value.

I understand

In order to be considered for network participation, please confirm that you can meet each of the requirements below by checking each item. If you are unable to meet any of the below requirements, please contact Jodi Ingram, VP of Quality and Population Health to discuss a CIN Action Plan for your participation to be considered.

Effectively utilize an electronic medical record (EMR)

Interface your EMR with the CGHN Health Information Exchange (CGHE) or GRAChIE

Send clinical data to CGHE or GRAChIE

Submit quality data to CGHN for Clinical Integration Measures based on specialty on a quarterly basis and actively engage in CGHN attempts to improve quality

Ability to submit billing codes/utilization if needed

I understand that my membership may require face to face meetings with CGHN staff members from time to time for information, training and educational purposes related to quality and clinical integration.

I certify that all information is accurate and I wish to join the CGHN Network. I understand that this application must be Board approved and acceptance is not guaranteed.

CGHN Pre-Application for Membership

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