Get Kaiser Permanente Ancillary Provider Enrollment Form
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How to fill out the Kaiser Permanente Ancillary Provider Enrollment Form online
Filling out the Kaiser Permanente Ancillary Provider Enrollment Form online is an essential step for healthcare practitioners or ancillary service providers looking to participate in the Kaiser Permanente network. This guide offers step-by-step instructions to ensure a smooth and accurate submission of your application.
Follow the steps to complete your enrollment form successfully.
- Click ‘Get Form’ button to obtain the form and open it for filling out.
- Begin by providing your group or practice name in the designated field. Ensure that it matches the name used in your official documentation to avoid discrepancies.
- Fill in the Federal Tax ID Number and NPI Number accurately. These identifiers are crucial for processing your application.
- Provide the contact name and street address of your practice. Ensure all information is legible and complete to prevent automatic denial of your application.
- Enter the city, state, zip code, and phone number for your main practice location. Include a fax number and email address for communication purposes as well.
- List the facility locations if applicable, ensuring each entry is clear and complete.
- Specify the major specialties your practice covers, citing at least one but no more than three specialties offered.
- Indicate any foreign languages spoken by staff that can assist patients with language needs.
- Document any hospitals where the providers have admitting or staff privileges, listing at least one but no more than three.
- Answer the yes/no questions regarding operational aspects of your practice, such as 24/7 coverage and insurance practices, ensuring you answer truthfully to avoid any issues with your application.
- Once all sections are completed, review the form thoroughly to ensure there are no errors or omissions.
- Save changes to your application, and download or print it for your records as you prepare for submission.
Complete your application for Kaiser Permanente participation online to get started.
To get credentialed with Kaiser, you must complete a series of steps, beginning with submitting your credentials and documentation. It’s essential to meet all qualifications outlined by Kaiser, which may include completing the Kaiser Permanente Ancillary Provider Enrollment Form. This process helps establish your qualifications, ensuring you can provide quality care to patients.
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