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Get Multiplan Provider Enrollment
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How to fill out the Multiplan Provider Enrollment online
Completing the Multiplan Provider Enrollment application is an essential step in joining the PHCS and MultiPlan Networks. This guide provides clear, step-by-step instructions to assist you in accurately filling out the necessary form online.
Follow the steps to successfully complete your provider enrollment.
- Click ‘Get Form’ button to access the Multiplan Provider Enrollment form and open it in the designated online editor.
- Begin by filling out the registration section with your last name, first name, middle initial, gender, and birth date. Ensure that you provide an accurate social security number as this data is handled confidentially.
- Enter your email address and indicate your primary specialty along with any additional specializations you wish to be referred for. Clearly specify your medical education details including school, city, state, and country.
- Detail your professional liability (malpractice) insurance information, including whether you maintain your current limits, along with the carrier and expiration date.
- If applicable, provide details regarding your DEA certification and whether you administer or prescribe controlled substances.
- Complete the address information section by providing the necessary practice, billing, and mailing addresses. Confirm whether this office is your primary location, if it is open to new patients, and if it is accessible for individuals with disabilities.
- Fill out the office hours for each day of the week, including after-hours coverage information.
- When detailing your tax information, ensure that the Tax Identification Number matches the documentation on your W-9 form. Repeat this process for any additional addresses.
- Review and complete the attestation section by signing the application, verifying that all information is accurate and true, and indicating the date of submission.
- Finally, remember to attach the necessary documents including a completed and signed MultiPlan Participating Professional Agreement, a copy of your W-9 form, and optionally, your Curriculum Vitae. Save the form, download, print, or share as required.
Begin filling out your Multiplan Provider Enrollment form online today.
Provider credentialing is the process of verifying a healthcare provider’s qualifications, experience, and professional history. This process ensures that the provider meets the necessary standards for participation in health plans and networks. A solid grasp of provider credentialing is essential when navigating the Multiplan Provider Enrollment process.
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