Get Ky Only Hwhn Practitioner Agreement - Webcvo

Completing the KY ONLY HWHN Practitioner Agreement online is a crucial step for practitioners wishing to participate in Healthways WholeHealth Networks, Inc. This guide will provide you with clear, step-by-step instructions to ensure a seamless experience in filling out the form correctly.

Follow the steps to complete the practitioner agreement accurately.

1. Use the 'Get Form' button to acquire the form and access it in the editor of your choice.
2. Begin by filling in your name in the designated space for 'Practitioner' to identify yourself clearly on the agreement.
3. Specify your licensed specialty or specialties in the provided field; this helps define your professional qualifications.
4. Sign the form in the required section to indicate your agreement with the terms outlined in the document.
5. Date your signature in the appropriate box to confirm when you completed the agreement.
6. Fill out the primary location information including your address, city, state, zip, and phone number, ensuring accuracy for contact purposes.
7. Include any secondary location details if applicable, following the same format as the primary location to provide additional context.
8. Enter your National Provider Identifier (NPI) number to meet identification requirements.
9. Complete the fields for your educational background, license number, tax ID, and license expiration date for thoroughness.
10. List your malpractice carrier and coverage limits, along with any expiration dates relevant to your insurance.
11. Provide your email address to facilitate communication regarding your agreement.
12. Specify your average fee range and payment methods accepted to clarify your financial expectations.
13. After filling out all sections, review the form for accuracy, ensuring all required fields are completed.
14. Save your changes, and you'll have the option to download, print, or share the completed form for your records.

Complete the KY ONLY HWHN Practitioner Agreement online to ensure your participation with Healthways WholeHealth Networks.