Ate Zip Code Phone Number Fax Number Website Address Tax ID Number New Agent Information First, Middle and Last Name Email Address Home Address City County State Zip Code Home Phone Cell Phone Date of Birth City of Birth Social Security Number Resident State Resident Agent License Number Non-Resident Agent License Number FFM User ID State National Producer Number Expiration Date Expiration Date Special Considerations (Example: Languages Spoken) Request for MAPD Sales Certif.
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How to fill out the Dean Health Plan Agent Information Sheet online
Filling out the Dean Health Plan Agent Information Sheet online is a crucial step for agents looking to work with Dean Health Plan. This guide provides a clear and supportive approach to completing the form accurately and efficiently.
Follow the steps to complete the Agent Information Sheet online.
- Click ‘Get Form’ button to obtain the form and open it in the editor.
- Begin with the contracted agency information section. Fill in the business name and address, including city, state, zip code, phone number, fax number, website address, and tax ID number.
- Next, complete the new agent information section. Provide your first, middle, and last name, email address, and home address (including city, county, state, zip code). Also, include your home phone and cell phone numbers, date of birth, city of birth, social security number, resident state, and both the resident and non-resident agent license numbers.
- Enter your FFM user ID, national producer number, and expiration date. If applicable, indicate any special considerations such as languages spoken and check the box for the request for MAPD sales certification.
- Respond to the criminal history and other questions by selecting 'Yes' or 'No' for each prompt. If you answer 'Yes' to any question, be prepared to provide a description on a separate page.
- Fill in the current E&O insurance carrier's name and policy number. Ensure all necessary information is provided and verified.
- Read the authorization statement. Understand the implications of the investigative consumer report and confirm that the information you have provided is accurate. Sign and date the form.
- Finally, save your changes. You can choose to download, print, or share the completed form as needed.
Complete your Dean Health Plan Agent Information Sheet online today to ensure a smooth application process.
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What is the payer ID for Dean Health Plan?
Providers who are set up to exchange EDI transactions with Dean Health Plan Commercial will continue to use them for the SSM Health Employee Health Plan transactions. The Payer ID is 39113.
Who bought out Dean Health Plan?
Last year, Minnesota-based Medica acquired 55% of Madison-based Dean Health Plan for $232.7 million, ing to a Wisconsin State Journal report. The details of the sale completed on Dec. 1, 2021, were recently made public.
Who owns Dean Health?
SSM Health Dean Medical Group joined the SSM Health system in September 2013. SSM Health is headquartered in St. Louis and owns several hospitals nationwide, including SSM Health St.
Did Medica buy Dean Health Plan?
With SSM Health's 2021 agreement with Medica – an independent, non-profit health plan headquartered in Minnetonka, MN., Dean Health Plan and Medica became partners.
Is SSM Health the same as Dean?
Dean Health Plan was established in 1983 as the insurance services subsidiary of Dean Health System and SSM Health Care. Together they created one of the largest integrated healthcare delivery systems in the country and deliver a superior level of service and care. Dean Clinic was first established in 1904 by Dr.
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