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Get Multiplan Provider Enrollment

LtiPlan, Inc. This application will serve to qualify you for participation in both the PHCS Network (primary PPO) and The MultiPlan Network (complementary network). To ensure appropriate referrals and facilitate timely payment of claims, we ask that you complete all items on this form. Items marked with an asterisk (*) will be kept confidential to the extent permitted by law. If you need assistance completing this form, please call our Service Operations Department at 1-800-950-7040. LAST NAME.

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