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Select Network HMO Submit your completed form to: E-mail: Underwritten by Altius Health Plans Inc. dba Coventry Health Care of Nevada Change Request Form Important: Please print clearly in BLACK ink.

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This verification process is commonly referred to as provider credentialing. You will need to provide a significant amount of enrollment information including documentation, including diplomas, certifications, work records, affiliations, tax information, proof of insurance, immunizations, and much more.

Credentialing is a vital process for healthcare institutions. In simple terms, credentialing is the process of assessing the academic qualifications and clinical practice history of a healthcare provider.

Please note: HPSM currently accepts electronic claims from two different clearinghouses, Office Ally (Payer ID: HPSM1) and Change Healthcare (Payer ID: SX174 for 837 professional & 12X74 for 837 Institutional).

Payer enrollment is the process of a provider joining a health insurance plan's network. The process includes requesting participation in a payer network, completing credentialing requirements, submitting documents to the payer, and signing a contract.

Insurance credentialing (or Provider Enrollment) refers to the process of applying to health insurance networks for inclusion in their provider panels. For Commercial Insurance networks, this process involves two steps, 1) Credentialing and 2) Contracting.

While medical credentialing is an essential process to certify a provider's qualifications, payer enrollment is the process of requesting participation in a health insurance network as a medical provider.

Your claims must be submitted within 180 days from the date of service in order to qualify for the full approved payment amount.

Claims not submitted within 365 days (12 months) from the date of service cannot be considered for payment.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232